Provider Demographics
NPI:1619308749
Name:JAVAID, SHAFAQ (LCPC)
Entity Type:Individual
Prefix:
First Name:SHAFAQ
Middle Name:
Last Name:JAVAID
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 1:1701 E WOODFIELD ROAD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5113
Mailing Address - Country:US
Mailing Address - Phone:847-240-2211
Mailing Address - Fax:847-240-2418
Practice Address - Street 1:350 E CONGRESS PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6284
Practice Address - Country:US
Practice Address - Phone:815-356-5050
Practice Address - Fax:815-356-5094
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILJ130-7808-4708OtherDRIVER'S LICENSE