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General NPI Number Information
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NPI Number | 1275866774
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Entity Type | Individual
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Provider Name | ANGELA SILVESTROS-GKIZAS LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 11227 DISTINCTIVE DR
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City | ORLAND PARK
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State | IL
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Zip | 60467-9458
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Country | US
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Telephone | 815-212-5666
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Fax |
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Provider Business Mailing Address
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Address Line | 13730 LARKSPUR DR
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City | HOMER GLEN
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State | IL
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Zip | 60491-8202
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Country | US
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Telephone | 815-955-1492
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-006552
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License Number State | IL
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