Healthcare Provider Details

I. General information

NPI: 1134585904
Provider Name (Legal Business Name): ANGEL MARKIN LCPC CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LAKE ST
OAK PARK IL
60302-2606
US

IV. Provider business mailing address

1100 LAKE ST
OAK PARK IL
60301-1015
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-0113
  • Fax: 708-383-9911
Mailing address:
  • Phone: 773-766-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180009149
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: