Provider Demographics
NPI:1588422372
Name:ALI, SAMIRAH S (LCPC)
Entity type:Individual
Prefix:
First Name:SAMIRAH
Middle Name:S
Last Name:ALI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:55 S HALE ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6277
Mailing Address - Country:US
Mailing Address - Phone:217-552-9758
Mailing Address - Fax:
Practice Address - Street 1:1401 MCHENRY RD STE 122
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1383
Practice Address - Country:US
Practice Address - Phone:847-913-0393
Practice Address - Fax:847-913-9630
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL180015659101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional