Provider Demographics
NPI:1376261081
Name:KOVALEVA, ANNA NIKOLAYEVNA (LCPC,MA,NCC)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:NIKOLAYEVNA
Last Name:KOVALEVA
Suffix:
Gender:F
Credentials:LCPC,MA,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 PICKWICK LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1508
Mailing Address - Country:US
Mailing Address - Phone:224-425-9169
Mailing Address - Fax:
Practice Address - Street 1:3471 GREEN BAY ROAD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-1344
Practice Address - Country:US
Practice Address - Phone:847-473-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional