Provider Demographics
NPI:1477231884
Name:STELLA, SANNA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SANNA
Middle Name:
Last Name:STELLA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1043
Mailing Address - Country:US
Mailing Address - Phone:708-308-5470
Mailing Address - Fax:
Practice Address - Street 1:2744 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2343
Practice Address - Country:US
Practice Address - Phone:773-434-4626
Practice Address - Fax:773-303-8858
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019166101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health