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General NPI Number Information
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NPI Number | 1437678927
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Entity Type | Individual
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Provider Name | ANTONINA SOPHIA LUNETTA MA, LPC, LLPC, IMH-E
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Gender | Female
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 633 W ADDISON ST
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City | CHICAGO
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State | IL
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Zip | 60613
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Country | US
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Telephone | 517-614-8918
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Fax |
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Provider Business Mailing Address
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Address Line | 777 N MICHIGAN AVE APT 2605
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City | CHICAGO
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State | IL
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Zip | 60611-7007
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Country | US
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Telephone | 517-614-8918
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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 | 640106547
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License Number State | MI
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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 | 178013792
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License Number State | IL
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