Provider Demographics
NPI:1639110612
Name:SOLIS, ANGELA (LCPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SOLIS
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 1:1802 N DIVISION ST STE 509
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3107
Mailing Address - Country:US
Mailing Address - Phone:815-941-3882
Mailing Address - Fax:815-941-3884
Practice Address - Street 1:1802 N DIVISION ST STE 509
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3107
Practice Address - Country:US
Practice Address - Phone:815-941-3882
Practice Address - Fax:815-941-3884
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14623101YA0400X
IL180003593101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)