Provider Demographics
NPI:1134201429
Name:EIZIK, CAROLINE MARY (LCPC)
Entity type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:MARY
Last Name:EIZIK
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 1:410 S MICHIGAN AVE STE 630
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1452
Mailing Address - Country:US
Mailing Address - Phone:773-297-6429
Mailing Address - Fax:
Practice Address - Street 1:410 S MICHIGAN AVE STE 630
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1452
Practice Address - Country:US
Practice Address - Phone:773-297-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional