Provider Demographics
NPI:1316747538
Name:NORTHSIDE CENTER FOR RELATIONSHIP COUNSELING
Entity type:Organization
Organization Name:NORTHSIDE CENTER FOR RELATIONSHIP COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:HETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LCPC
Authorized Official - Phone:773-791-0469
Mailing Address - Street 1:5100 N RAVENSWOOD AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1710
Mailing Address - Country:US
Mailing Address - Phone:773-791-0469
Mailing Address - Fax:
Practice Address - Street 1:5100 N RAVENSWOOD AVE STE 208
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1710
Practice Address - Country:US
Practice Address - Phone:773-791-0469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSIDE CENTER FOR RELATIONSHIP COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-17
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)