Healthcare Provider Details

I. General information

NPI: 1831883925
Provider Name (Legal Business Name): ANNA ELAGINA COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24047 W LOCKPORT ST STE 201G
PLAINFIELD IL
60544-1680
US

IV. Provider business mailing address

404 W BOUGHTON RD STE A
BOLINGBROOK IL
60440-1898
US

V. Phone/Fax

Practice location:
  • Phone: 872-760-4353
  • Fax:
Mailing address:
  • Phone: 872-760-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANNA ELAGINA
Title or Position: OWNER
Credential: LCPC
Phone: 872-760-4353