Healthcare Provider Details

I. General information

NPI: 1730402884
Provider Name (Legal Business Name): DARLENE KATRINA ALEXANDER LCPC,NCC,MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16547 OAK PARK AVE
TINLEY PARK IL
60477-1752
US

IV. Provider business mailing address

16547 OAK PARK AVE
TINLEY PARK IL
60477-1752
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-9003
  • Fax: 708-633-1823
Mailing address:
  • Phone: 708-633-9003
  • Fax: 708-633-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008722
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: