Provider Demographics
NPI:1811467806
Name:SOUFLAKIS, ATHANASIA (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ATHANASIA
Middle Name:
Last Name:SOUFLAKIS
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 1:244 MICHAEL MNR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4632
Mailing Address - Country:US
Mailing Address - Phone:708-203-7454
Mailing Address - Fax:
Practice Address - Street 1:244 MICHAEL MNR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4632
Practice Address - Country:US
Practice Address - Phone:708-203-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011917101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor