Provider Demographics
NPI:1326328451
Name:YURCHANKA, DINA
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:YURCHANKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 N BLOOMINGTON AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1183
Mailing Address - Country:US
Mailing Address - Phone:224-730-9376
Mailing Address - Fax:
Practice Address - Street 1:3800 N WILKE RD STE 160
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1286
Practice Address - Country:US
Practice Address - Phone:224-730-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional