Healthcare Provider Details

I. General information

NPI: 1629987763
Provider Name (Legal Business Name): CRISTINA VIRGINIA DUSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 GRAND AVE
FRANKLIN PARK IL
60131-2563
US

IV. Provider business mailing address

7231 WOLF RD UNIT 306
INDIAN HEAD PARK IL
60525-4950
US

V. Phone/Fax

Practice location:
  • Phone: 847-451-0330
  • Fax:
Mailing address:
  • Phone: 404-317-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: