Healthcare Provider Details

I. General information

NPI: 1679925333
Provider Name (Legal Business Name): DUPAGE CREATIVE COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N CASS AVE STE 109
WESTMONT IL
60559-6401
US

IV. Provider business mailing address

8720 COVENTRY DR
WOODRIDGE IL
60517-7502
US

V. Phone/Fax

Practice location:
  • Phone: 309-825-6311
  • Fax: 630-791-5427
Mailing address:
  • Phone: 309-825-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.008394
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number180.008394
License Number StateIL

VIII. Authorized Official

Name: RACHEL WAGNER-CANTINE
Title or Position: OWNER
Credential: LCPC, BC-DMT
Phone: 309-825-6311