Healthcare Provider Details

I. General information

NPI: 1386074037
Provider Name (Legal Business Name): ANTONIA KATSAROS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2013
Last Update Date: 11/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 STURBRIDGE CT
HOFFMAN ESTATES IL
60192-1369
US

IV. Provider business mailing address

1450 STURBRIDGE CT
HOFFMAN ESTATES IL
60192-1369
US

V. Phone/Fax

Practice location:
  • Phone: 847-712-3022
  • Fax:
Mailing address:
  • Phone: 847-712-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.006651
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: