Provider Demographics
NPI:1679925333
Name:DUPAGE CREATIVE COUNSELING INC.
Entity Type:Organization
Organization Name:DUPAGE CREATIVE COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER-CANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, BC-DMT
Authorized Official - Phone:309-825-6311
Mailing Address - Street 1:8720 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7502
Mailing Address - Country:US
Mailing Address - Phone:309-825-6311
Mailing Address - Fax:
Practice Address - Street 1:16W241 S FRONTAGE RD STE 35
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6169
Practice Address - Country:US
Practice Address - Phone:309-825-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008394261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health