Healthcare Provider Details

I. General information

NPI: 1013853415
Provider Name (Legal Business Name): SIMONA ATANASSOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 HERITAGE DR
CRYSTAL LAKE IL
60014-8068
US

IV. Provider business mailing address

1015 DEERFIELD RD APT 235
DEERFIELD IL
60015-4152
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-4727
  • Fax:
Mailing address:
  • Phone: 773-968-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: