Provider Demographics
NPI:1497896120
Name:MEDINA, ZAIDA (LCPC)
Entity Type:Individual
Prefix:DR
First Name:ZAIDA
Middle Name:
Last Name:MEDINA
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 1:3583 BACKSHORE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7504
Mailing Address - Country:US
Mailing Address - Phone:224-381-2824
Mailing Address - Fax:
Practice Address - Street 1:300 CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1525
Practice Address - Country:US
Practice Address - Phone:224-381-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006654101YP2500X
IL178003554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL710957905OtherFEIN
IL04932271OtherBLUE SHIELD