Provider Demographics
NPI:1578673075
Name:PRICE, THEODORA HADZISTELIOU (PHD AEEH MSW LCSW AC)
Entity Type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:HADZISTELIOU
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHD AEEH MSW LCSW AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PEBBLE CT
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-378-1187
Mailing Address - Fax:630-378-4278
Practice Address - Street 1:10 PEBBLE CT
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-378-1187
Practice Address - Fax:630-378-4278
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL026308103T00000X
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist