Provider Demographics
NPI:1427235274
Name:CHRISTINE, SHELL (LCPC CRADC NCC)
Entity type:Individual
Prefix:MS
First Name:SHELL
Middle Name:
Last Name:CHRISTINE
Suffix:
Gender:F
Credentials:LCPC CRADC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 ANCHOR DRIVE
Mailing Address - Street 2:#501
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:708-308-3721
Mailing Address - Fax:
Practice Address - Street 1:1414 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3902
Practice Address - Country:US
Practice Address - Phone:708-786-8541
Practice Address - Fax:708-681-3958
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13056101YA0400X
IL75018101YM0800X
IL180006736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health