Healthcare Provider Details

I. General information

NPI: 1306771019
Provider Name (Legal Business Name): DEMETRIA GIANNAKOURAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W LAKE COOK RD
BUFFALO GROVE IL
60089-1926
US

IV. Provider business mailing address

1242 N KNOLLWOOD DR
PALATINE IL
60067-2075
US

V. Phone/Fax

Practice location:
  • Phone: 847-386-7192
  • Fax:
Mailing address:
  • Phone: 847-807-9165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: