Provider Demographics
NPI:1003336629
Name:WELLVANG, CARA ELIANA FISHER (LPC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:ELIANA FISHER
Last Name:WELLVANG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:ELIANA
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1702 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3713
Mailing Address - Country:US
Mailing Address - Phone:847-425-9708
Mailing Address - Fax:
Practice Address - Street 1:1702 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3713
Practice Address - Country:US
Practice Address - Phone:847-425-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional