Provider Demographics
NPI:1164707071
Name:SMITH, VALERIE KARA (LCPC CADC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:KARA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 SUSAN COLLINS LN APT 505
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-5412
Mailing Address - Country:US
Mailing Address - Phone:708-415-7993
Mailing Address - Fax:
Practice Address - Street 1:115 N OAK PARK AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1345
Practice Address - Country:US
Practice Address - Phone:708-445-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007693101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional