Provider Demographics
NPI:1710684550
Name:VERVILOS, MONICA (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:VERVILOS
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MILWAUKEE AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3555
Mailing Address - Country:US
Mailing Address - Phone:847-370-0606
Mailing Address - Fax:847-787-5249
Practice Address - Street 1:1020 MILWAUKEE AVE STE 235
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3555
Practice Address - Country:US
Practice Address - Phone:847-370-0606
Practice Address - Fax:847-787-5249
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional