Provider Information for 1639812795
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CONSTANCE TOLIVER LCSW
Sex: Female
NPI: 1639812795
Last Updated: 2022-04-17
Certification Date: 2022-04-17
Certification Date: 2022-04-17
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1639812795 | ||||||||||||||
| Enumeration Date | 2022-04-17 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 4938 S CHAMPLAIN AVE APT 2S CHICAGO, IL 60615-2546 United States Phone: 773-312-2047 | Fax: | ||||||||||||||
| Primary Practice Address | 4938 S CHAMPLAIN AVE APT 2S CHICAGO, IL 60615-2546 United States Phone: 773-312-2047 | Fax: | ||||||||||||||
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