Provider Demographics
NPI:1306628318
Name:THE MINDFUL SISTAH WELLNESS AND COUNSELING SERVICES
Entity type:Organization
Organization Name:THE MINDFUL SISTAH WELLNESS AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TOYIA
Authorized Official - Middle Name:ARNETTA
Authorized Official - Last Name:MILLER-PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-824-7225
Mailing Address - Street 1:3643 W DEER PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-1085
Mailing Address - Country:US
Mailing Address - Phone:773-412-6996
Mailing Address - Fax:
Practice Address - Street 1:3643 W DEER PARK DR
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1085
Practice Address - Country:US
Practice Address - Phone:708-824-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty