Provider Demographics
NPI:1902076417
Name:CARROLL, CAYAMA (MA, LCPC)
Entity type:Individual
Prefix:MS
First Name:CAYAMA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:MRS
Other - First Name:CAYAMA
Other - Middle Name:
Other - Last Name:IVESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7100 S SOUTH SHORE DR
Mailing Address - Street 2:#706
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2700
Mailing Address - Country:US
Mailing Address - Phone:772-544-6295
Mailing Address - Fax:
Practice Address - Street 1:67 E MADISON ST
Practice Address - Street 2:SUITE 1421
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3014
Practice Address - Country:US
Practice Address - Phone:773-544-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional