Provider Demographics
NPI:1841536489
Name:CHARLEY-GAD, KATHERINE ANN (LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANN
Last Name:CHARLEY-GAD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E GARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-2132
Mailing Address - Country:US
Mailing Address - Phone:847-846-3946
Mailing Address - Fax:
Practice Address - Street 1:3800 N WILKE RD
Practice Address - Street 2:STE 160
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1278
Practice Address - Country:US
Practice Address - Phone:847-846-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health