Healthcare Provider Details

I. General information

NPI: 1861869208
Provider Name (Legal Business Name): CHRISTOPHER POULAKOS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 MCDOWELL ROAD SUITE 305
NAPERVILLE IL
60563
US

IV. Provider business mailing address

1952 MCDOWELL ROAD SUITE 305
NAPERVILLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 630-689-1022
  • Fax: 630-689-1023
Mailing address:
  • Phone: 630-689-1022
  • Fax: 630-689-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: