Provider Demographics
NPI:1720862238
Name:LANKFORD, SASHA RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:RENEE
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 SCHILLER AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2326
Mailing Address - Country:US
Mailing Address - Phone:815-557-5736
Mailing Address - Fax:
Practice Address - Street 1:2130 SCHILLER AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2326
Practice Address - Country:US
Practice Address - Phone:815-557-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178019288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional