Provider Demographics
NPI:1194076406
Name:PERISEE-JOHNS, VICTORIA IRIS (LCPC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:IRIS
Last Name:PERISEE-JOHNS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:I
Other - Last Name:PERISEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 LAKE ST STE 405B
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1085
Mailing Address - Country:US
Mailing Address - Phone:708-584-4577
Mailing Address - Fax:708-584-4622
Practice Address - Street 1:1101 LAKE ST STE 405B
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1085
Practice Address - Country:US
Practice Address - Phone:708-584-4577
Practice Address - Fax:708-584-4622
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILM.A.101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional