Provider Demographics
NPI:1780917914
Name:WAMBLE, MERRIAM ELIZABETH (MS, LCPC, RDDP)
Entity type:Individual
Prefix:MS
First Name:MERRIAM
Middle Name:ELIZABETH
Last Name:WAMBLE
Suffix:
Gender:F
Credentials:MS, LCPC, RDDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 N MARCEY ST
Mailing Address - Street 2:SUITE 535 -TERRY HEFTER ASSOCIATES
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5373
Mailing Address - Country:US
Mailing Address - Phone:312-280-1166
Mailing Address - Fax:312-280-1199
Practice Address - Street 1:1731 N MARCEY ST
Practice Address - Street 2:SUITE 535 -TERRY HEFTER ASSOCIATES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5373
Practice Address - Country:US
Practice Address - Phone:312-280-1166
Practice Address - Fax:312-280-1199
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health