Provider Demographics
NPI:1326442674
Name:PETROHILOS, ALEXANDRA A (LCPC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:A
Last Name:PETROHILOS
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 1:19 N GRANT ST
Mailing Address - Street 2:SUITE L-C
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3363
Mailing Address - Country:US
Mailing Address - Phone:630-286-2785
Mailing Address - Fax:
Practice Address - Street 1:19 N GRANT ST
Practice Address - Street 2:SUITE L-C
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3363
Practice Address - Country:US
Practice Address - Phone:630-286-2785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional