Provider Demographics
NPI:1851451272
Name:CHAN, ANN LUCIA (LCPC, LCSW)
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:LUCIA
Last Name:CHAN
Suffix:
Gender:F
Credentials:LCPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 S ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-6711
Mailing Address - Country:US
Mailing Address - Phone:217-390-2917
Mailing Address - Fax:
Practice Address - Street 1:206 N RANDOLPH ST STE 401
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-8812
Practice Address - Country:US
Practice Address - Phone:217-390-2917
Practice Address - Fax:217-355-1866
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.004709104100000X
IL180.006166101YP2500X
IL14653461041S0200X
IL149.0127971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool