Provider Demographics
NPI:1720827108
Name:EMBRACE COUNSELING AND WELLNESS, PLLC
Entity type:Organization
Organization Name:EMBRACE COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:LANAE
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-343-6789
Mailing Address - Street 1:2300 S MICHIGAN AVE APT 716
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 S MICHIGAN AVE APT 716
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2115
Practice Address - Country:US
Practice Address - Phone:214-659-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty