Provider Demographics
NPI:1235455148
Name:WAGNER-CANTINE, RACHEL K (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:K
Last Name:WAGNER-CANTINE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:K
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:8720 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7502
Mailing Address - Country:US
Mailing Address - Phone:309-825-6311
Mailing Address - Fax:
Practice Address - Street 1:825 N CASS AVE STE 109
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6401
Practice Address - Country:US
Practice Address - Phone:309-825-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008394101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health