Provider Demographics
NPI:1275866774
Name:SILVESTROS-GKIZAS, ANGELA (LCPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SILVESTROS-GKIZAS
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 1:13730 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8202
Mailing Address - Country:US
Mailing Address - Phone:815-955-1492
Mailing Address - Fax:
Practice Address - Street 1:11227 DISTINCTIVE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9458
Practice Address - Country:US
Practice Address - Phone:815-212-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional