Provider Demographics
NPI:1124276654
Name:OLOFFSON, GREGORY A (LCPC CADC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:OLOFFSON
Suffix:
Gender:M
Credentials:LCPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E OGDEN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5534
Mailing Address - Country:US
Mailing Address - Phone:630-920-9693
Mailing Address - Fax:
Practice Address - Street 1:350 E OGDEN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5534
Practice Address - Country:US
Practice Address - Phone:630-920-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12162101YA0400X
IL180000519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)