Provider Demographics
NPI:1437750320
Name:CARBAJAL, ELIANA MARIA (LPC)
Entity Type:Individual
Prefix:
First Name:ELIANA
Middle Name:MARIA
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 HICKMAN LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3028
Mailing Address - Country:US
Mailing Address - Phone:815-355-2421
Mailing Address - Fax:
Practice Address - Street 1:445 PARK AVE STE F
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2766
Practice Address - Country:US
Practice Address - Phone:224-699-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional