Provider Demographics
NPI:1639667850
Name:DERKIN, EMILY (LCPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DERKIN
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 1:2118 N CAMPBELL AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4102
Mailing Address - Country:US
Mailing Address - Phone:773-540-5530
Mailing Address - Fax:
Practice Address - Street 1:2118 N CAMPBELL AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4102
Practice Address - Country:US
Practice Address - Phone:773-540-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009578101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional