Provider Demographics
NPI:1891427282
Name:DEMEOLA, CHRISTINA (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DEMEOLA
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4010
Mailing Address - Country:US
Mailing Address - Phone:773-758-0945
Mailing Address - Fax:
Practice Address - Street 1:2102 LAURA LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-4010
Practice Address - Country:US
Practice Address - Phone:773-758-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional