Provider Demographics
NPI:1962639310
Name:VANEYCKE, CATHERINE L (LCSW, CADC, CDVP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:VANEYCKE
Suffix:
Gender:F
Credentials:LCSW, CADC, CDVP
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:VAN EYCKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5825 FARNHAM CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5305
Mailing Address - Country:US
Mailing Address - Phone:630-400-2506
Mailing Address - Fax:
Practice Address - Street 1:514 MARKET LOOP
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2148
Practice Address - Country:US
Practice Address - Phone:630-400-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2002 073101Y00000X
IL13338101YA0400X
101YM0800X
IL149.0133911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health