Provider Demographics
NPI:1104556281
Name:SIMON, CAROLYN CELINE (LPC)
Entity type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:CELINE
Last Name:SIMON
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 1:628 W SURF ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5384
Mailing Address - Country:US
Mailing Address - Phone:847-243-7788
Mailing Address - Fax:
Practice Address - Street 1:1950 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4565
Practice Address - Country:US
Practice Address - Phone:312-806-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health