Healthcare Provider Details

I. General information

NPI: 1922737998
Provider Name (Legal Business Name): DEMETRIUS BALDWIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAKE ST STE 110
OAK PARK IL
60301-1106
US

IV. Provider business mailing address

1010 LAKE ST STE 110
OAK PARK IL
60301-1106
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax: 630-428-7891
Mailing address:
  • Phone: 630-428-7890
  • Fax: 630-428-7891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022914
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC10220
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: