Kevin Connolly
Counselor, Professional in Bloomingdale, IL. Individual provider (NPI-1).
NPI number1124419643
StatusActive
Last updated in NPPESFeb 12, 2015
Details
- NPI
- 1124419643
- Entity type
- Individual (NPI-1)
- Name
- Kevin Connolly
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 6, 2015
- Last updated
- Feb 12, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 180009277 | IL | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 180009277 | IL | |
| 101YM0800X | Counselor, Mental Health | 180009277 | IL | |
| 106H00000X | Marriage & Family Therapist | 180009277 | IL |
Practice location
1 Tiffany Pt Ste 110Bloomingdale, IL 60108-2915
Phone 773-981-2972
Mailing address
1617 Lake AveWilmette, IL 60091-1535
Phone 773-981-2972
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