Provider Demographics
NPI:1003969247
Name:VIRGIL, ALICE K (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:K
Last Name:VIRGIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12979 W SANCTUARY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1139
Mailing Address - Country:US
Mailing Address - Phone:773-919-9170
Mailing Address - Fax:
Practice Address - Street 1:950 N WESTERN AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1742
Practice Address - Country:US
Practice Address - Phone:773-919-9170
Practice Address - Fax:773-919-9170
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0103801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical