Provider Demographics
NPI:1508976234
Name:ROMANOV, PRISCILLA A (LCPC)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:A
Last Name:ROMANOV
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 1:5612 W VON AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-7912
Mailing Address - Country:US
Mailing Address - Phone:708-534-1255
Mailing Address - Fax:708-429-9882
Practice Address - Street 1:15505 S 70TH CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5105
Practice Address - Country:US
Practice Address - Phone:708-308-3302
Practice Address - Fax:708-429-9882
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional