Provider Demographics
NPI:1104369032
Name:FRINGE COUNSELING, COACHING, AND CONSULTING
Entity type:Organization
Organization Name:FRINGE COUNSELING, COACHING, AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-266-4406
Mailing Address - Street 1:5954 W FULTON ST
Mailing Address - Street 2:1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-2114
Mailing Address - Country:US
Mailing Address - Phone:773-266-4406
Mailing Address - Fax:
Practice Address - Street 1:1525 CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2629
Practice Address - Country:US
Practice Address - Phone:773-266-4406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0187771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty