Provider Demographics
NPI:1700391778
Name:HANKINS, MARK (LCPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:HANKINS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7052 W SUMMERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1951
Mailing Address - Country:US
Mailing Address - Phone:773-502-6250
Mailing Address - Fax:
Practice Address - Street 1:360 W BUTTERFIELD RD STE 120
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5025
Practice Address - Country:US
Practice Address - Phone:630-492-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional