Provider Demographics
NPI:1942393657
Name:TABACCHI, GINA LINDA (LCPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LINDA
Last Name:TABACCHI
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 1:5100 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1710
Mailing Address - Country:US
Mailing Address - Phone:312-588-9977
Mailing Address - Fax:312-329-1248
Practice Address - Street 1:5100 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1710
Practice Address - Country:US
Practice Address - Phone:312-588-9977
Practice Address - Fax:312-329-1248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional