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General NPI Number Information
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NPI Number | 1255006128
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Entity Type | Individual
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Provider Name | CARISSA CAITLIN SABAL LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 3805 E MAIN ST STE M
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City | ST CHARLES
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State | IL
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Zip | 60174-2487
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Country | US
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Telephone | 630-646-5200
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Fax | 630-377-3745
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Provider Business Mailing Address
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Address Line | 3805 E MAIN ST STE M
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City | ST CHARLES
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State | IL
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Zip | 60174-2487
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Country | US
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Telephone | 630-646-5200
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Fax | 630-377-3745
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 34836
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180013566
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License Number State | IL
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