Provider Demographics
NPI:1801912795
Name:WHARTON, VIRGINIA W (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:W
Last Name:WHARTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 W ATTRILL ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4003
Mailing Address - Country:US
Mailing Address - Phone:312-259-2112
Mailing Address - Fax:847-998-8176
Practice Address - Street 1:3600 W WRIGHTWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1138
Practice Address - Country:US
Practice Address - Phone:312-259-2112
Practice Address - Fax:847-998-8176
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490150151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical