Provider Demographics
NPI:1114386927
Name:KHERAJ, SOFIA (LCPC)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:
Last Name:KHERAJ
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 1:803 N CAMPBELL AVE
Mailing Address - Street 2:# 2C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5457
Mailing Address - Country:US
Mailing Address - Phone:214-223-6142
Mailing Address - Fax:
Practice Address - Street 1:803 N CAMPBELL AVE
Practice Address - Street 2:# 2C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5457
Practice Address - Country:US
Practice Address - Phone:214-223-6142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health