Provider Demographics
NPI:1104417138
Name:SHALOM COUNSELING AND CONSULTING LLC
Entity type:Organization
Organization Name:SHALOM COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LCSW
Authorized Official - Prefix:
Authorized Official - First Name:LASHAUNNA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LESURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-305-1751
Mailing Address - Street 1:701 DEVONSHIRE DR STE 123
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7337
Mailing Address - Country:US
Mailing Address - Phone:217-766-1018
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DR STE 123
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7337
Practice Address - Country:US
Practice Address - Phone:217-305-1751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty