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General NPI Number Information
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NPI Number | 1912697202
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Entity Type | Individual
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Provider Name | SOFIA MARIANA LYNN LCPC, CADC
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Gender | Female
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1700 W IRVING PARK RD STE 301
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City | CHICAGO
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State | IL
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Zip | 60613-2462
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Country | US
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Telephone | 312-248-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 N PINE GROVE AVE APT 1614
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City | CHICAGO
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State | IL
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Zip | 60613-5508
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Country | US
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Telephone | 724-710-1071
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37433
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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 | 178.018975
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License Number State | IL
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