Provider Demographics
NPI:1285706978
Name:SMITH, CAROLINE WILCOX (LCPC,NCC,CAADC)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:WILCOX
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC,NCC,CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 KUMMER CT
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2929
Mailing Address - Country:US
Mailing Address - Phone:630-420-0074
Mailing Address - Fax:
Practice Address - Street 1:1613 KUMMER CT
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2929
Practice Address - Country:US
Practice Address - Phone:630-420-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18262101YA0400X
IL180-003660101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)