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General NPI Number Information
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NPI Number | 1245120187
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Entity Type | Individual
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Provider Name | STEFAN VASIC PHD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 444 N MICHIGAN AVE FL 30
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City | CHICAGO
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State | IL
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Zip | 60611-3964
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Country | US
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Telephone | 847-733-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 21 W MARSHALL ST
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City | RICHMOND
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State | VA
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Zip | 23220-3974
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704014978
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License Number State | VA
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