Provider Demographics
NPI:1780934372
Name:CONNOR, ANGELA J (LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:CONNOR
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 1:1724 E PATMORE ST
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60416-6031
Mailing Address - Country:US
Mailing Address - Phone:815-582-6818
Mailing Address - Fax:
Practice Address - Street 1:1724 E PATMORE ST
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:IL
Practice Address - Zip Code:60416-6031
Practice Address - Country:US
Practice Address - Phone:815-582-6818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178007601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional