Provider Demographics
NPI:1790320067
Name:JOACHIM, ANDRE N JR (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:N
Last Name:JOACHIM
Suffix:JR
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1104
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-7104
Mailing Address - Country:US
Mailing Address - Phone:815-603-2031
Mailing Address - Fax:
Practice Address - Street 1:1112 S WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7960
Practice Address - Country:US
Practice Address - Phone:630-848-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013202101YM0800X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health