Healthcare Provider Details

I. General information

NPI: 1124276654
Provider Name (Legal Business Name): GREGORY A OLOFFSON LCPC CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E OGDEN AVE SUITE 101
WESTMONT IL
60559-5534
US

IV. Provider business mailing address

350 E OGDEN AVE SUITE 101
WESTMONT IL
60559-5534
US

V. Phone/Fax

Practice location:
  • Phone: 630-920-9693
  • Fax:
Mailing address:
  • Phone: 630-920-9693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12162
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180000519
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: