Provider Demographics
NPI:1780202457
Name:CARDENAS, ALEJANDRA (LCPC)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:CARDENAS
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 1:903 S ASHLAND AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4094
Mailing Address - Country:US
Mailing Address - Phone:551-390-0685
Mailing Address - Fax:
Practice Address - Street 1:2259 S DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4232
Practice Address - Country:US
Practice Address - Phone:872-281-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015975101YP2500X
IL180.013869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional