Provider Demographics
NPI:1104392828
Name:DAHLEH, AMINA (LCPC)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:DAHLEH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17430 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5235
Mailing Address - Country:US
Mailing Address - Phone:708-299-6700
Mailing Address - Fax:
Practice Address - Street 1:9721 165TH ST STE 21
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4511
Practice Address - Country:US
Practice Address - Phone:708-671-8946
Practice Address - Fax:708-827-5014
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011842101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty