Provider Demographics
NPI:1497108682
Name:COWAN, RAINA S J (LCPC)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:S J
Last Name:COWAN
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 1:3411 W DIVERSEY AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1281
Mailing Address - Country:US
Mailing Address - Phone:773-609-3264
Mailing Address - Fax:
Practice Address - Street 1:3411 W DIVERSEY AVE STE 8
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1281
Practice Address - Country:US
Practice Address - Phone:773-609-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional