Provider Demographics
NPI:1063604262
Name:COTTAGE CLINIC COUNSELING, INC.
Entity type:Organization
Organization Name:COTTAGE CLINIC COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCH.; PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:V
Authorized Official - Last Name:DIGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-932-8443
Mailing Address - Street 1:115 MOONEY DR
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2147
Mailing Address - Country:US
Mailing Address - Phone:815-932-8443
Mailing Address - Fax:815-936-1295
Practice Address - Street 1:115 MOONEY DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2147
Practice Address - Country:US
Practice Address - Phone:815-932-8443
Practice Address - Fax:815-936-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty