Provider Demographics
NPI:1023557816
Name:ALEXANDRA PETROHILOS LLC
Entity Type:Organization
Organization Name:ALEXANDRA PETROHILOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROHILOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-286-2785
Mailing Address - Street 1:19 N GRANT ST
Mailing Address - Street 2:SUITE LC
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3363
Mailing Address - Country:US
Mailing Address - Phone:630-286-2785
Mailing Address - Fax:
Practice Address - Street 1:19 N GRANT ST
Practice Address - Street 2:SUITE LC
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3363
Practice Address - Country:US
Practice Address - Phone:630-286-2785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty