Provider Demographics
NPI:1972079119
Name:MORALES LOPEZ, VANESSA (LCPC, ICDVP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MORALES LOPEZ
Suffix:
Gender:F
Credentials:LCPC, ICDVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SPINNING WHEEL RD STE 34
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2914
Mailing Address - Country:US
Mailing Address - Phone:708-740-7904
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD STE 34
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2914
Practice Address - Country:US
Practice Address - Phone:708-740-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional