Provider Demographics
NPI:1346558020
Name:DECARLO, COURTNEY M (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:M
Last Name:DECARLO
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 1:2611 ROSEHALL LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-5686
Mailing Address - Country:US
Mailing Address - Phone:773-848-8438
Mailing Address - Fax:
Practice Address - Street 1:5 E WASHINGTON ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8622
Practice Address - Country:US
Practice Address - Phone:773-848-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional