Provider Demographics
NPI:1083302137
Name:FAULKNER, CELESTE TANIKA (LPC)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:TANIKA
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-5922
Mailing Address - Country:US
Mailing Address - Phone:773-908-3275
Mailing Address - Fax:
Practice Address - Street 1:5025 S ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-5922
Practice Address - Country:US
Practice Address - Phone:773-908-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional