Provider Demographics
NPI:1154198828
Name:BACK AGAIN COUNSELING STUDIO PLLC
Entity type:Organization
Organization Name:BACK AGAIN COUNSELING STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-277-9049
Mailing Address - Street 1:1320 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4309
Mailing Address - Country:US
Mailing Address - Phone:708-277-9049
Mailing Address - Fax:
Practice Address - Street 1:1320 TOWER RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4309
Practice Address - Country:US
Practice Address - Phone:708-277-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty