Healthcare Provider Details

I. General information

NPI: 1558092767
Provider Name (Legal Business Name): CAMILLE ELLIMAC-RAHEEM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E DIEHL RD STE 101
NAPERVILLE IL
60563-2394
US

IV. Provider business mailing address

PO BOX 4911
NAPERVILLE IL
60567-4911
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone: 630-877-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.019291
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.019291
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: