Provider Demographics
NPI:1619128543
Name:WAHLSTROM, CAROL L (LCPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:WAHLSTROM
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 1:2907 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1175
Mailing Address - Country:US
Mailing Address - Phone:630-586-0900
Mailing Address - Fax:630-586-9990
Practice Address - Street 1:2907 BUTTERFIELD RD
Practice Address - Street 2:SUITE 240
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1175
Practice Address - Country:US
Practice Address - Phone:630-586-0900
Practice Address - Fax:630-586-9990
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health