Provider Demographics
NPI:1427099811
Name:RAVINE, EDWARD STEVEN (LCPC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:STEVEN
Last Name:RAVINE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 OLDE HALF DAY ROAD
Mailing Address - Street 2:STE 140-14
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3069
Mailing Address - Country:US
Mailing Address - Phone:847-777-6922
Mailing Address - Fax:847-777-6923
Practice Address - Street 1:175 OLDE HALF DAY ROAD
Practice Address - Street 2:STE 140-14
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3069
Practice Address - Country:US
Practice Address - Phone:847-777-6922
Practice Address - Fax:847-777-6923
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional