Provider Demographics
NPI:1841407814
Name:VANCE, DEAN (LCPC)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:VANCE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:NOEL
Other - Middle Name:DEAN
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1220 W. ALBION
Mailing Address - Street 2:2 WEST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626
Mailing Address - Country:US
Mailing Address - Phone:772-443-7284
Mailing Address - Fax:
Practice Address - Street 1:4305 N LINCOLN
Practice Address - Street 2:SUITE G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-443-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional