Provider Demographics
NPI:1457159386
Name:THE BLACK SHEEP SANCTUARY PLLC
Entity type:Organization
Organization Name:THE BLACK SHEEP SANCTUARY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERPLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-709-1471
Mailing Address - Street 1:136 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1936
Mailing Address - Country:US
Mailing Address - Phone:630-709-1471
Mailing Address - Fax:
Practice Address - Street 1:3080 OGDEN AVE STE 104
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1693
Practice Address - Country:US
Practice Address - Phone:630-423-6244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty