MEDICARE: VICTORIA STANTON LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180012065	IL

General Provider Information

NPI Number	:	1487113387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA STANTON LCPC

Provider Business Mailing Address
First Line	:	1125 PLEASANT RUN DR APT 805
Second Line	:
City	:	WHEELING
State	:	IL
Zip	:	60090-5611
Country	:	US
Telephone Number	:	510-822-1388
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 N WESTERN AVE STE 104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2588
Country	:	US
Telephone Number	:	773-250-1769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	09/24/2020

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