Provider Demographics
NPI:1255006128
Name:SABAL, CARISSA CAITLIN (LCPC)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:CAITLIN
Last Name:SABAL
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 1:3805 E MAIN ST STE M
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2487
Mailing Address - Country:US
Mailing Address - Phone:630-646-5200
Mailing Address - Fax:630-377-3745
Practice Address - Street 1:3805 E MAIN ST STE M
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2487
Practice Address - Country:US
Practice Address - Phone:630-646-5200
Practice Address - Fax:630-377-3745
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34836101YA0400X
IL180013566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)