Provider Demographics
NPI:1336672963
Name:HAMBERLIN, ANGELA DIANE (LCPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIANE
Last Name:HAMBERLIN
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 1:3425 W 83RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-2517
Mailing Address - Country:US
Mailing Address - Phone:630-479-4880
Mailing Address - Fax:
Practice Address - Street 1:3425 W 83RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-2517
Practice Address - Country:US
Practice Address - Phone:630-479-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional