Provider Demographics
NPI:1972154540
Name:LOTT, TINA (EDD, LCPC,CADC, ACS)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:EDD, LCPC,CADC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 CAINE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-6125
Mailing Address - Country:US
Mailing Address - Phone:773-940-6043
Mailing Address - Fax:
Practice Address - Street 1:3804 CAINE CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-6125
Practice Address - Country:US
Practice Address - Phone:773-940-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009195101YM0800X
COLPC.0020470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health