Provider Demographics
NPI:1558937144
Name:DETCHEVSKA, PETIA (LCPC)
Entity Type:Individual
Prefix:
First Name:PETIA
Middle Name:
Last Name:DETCHEVSKA
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 1:2001 BUTTERFIELD RD STE 320
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5466
Mailing Address - Country:US
Mailing Address - Phone:847-493-3600
Mailing Address - Fax:847-493-3627
Practice Address - Street 1:2001 BUTTERFIELD RD STE 320
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5466
Practice Address - Country:US
Practice Address - Phone:847-493-3600
Practice Address - Fax:847-493-3627
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional