Provider Demographics
NPI:1992312706
Name:GONTERMAN, CAROLYN ELAINE (LCPC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELAINE
Last Name:GONTERMAN
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 1/2 W ESTES AVE APT 33
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5409
Mailing Address - Country:US
Mailing Address - Phone:708-726-5022
Mailing Address - Fax:
Practice Address - Street 1:1321 1/2 W ESTES AVE APT 33
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-5409
Practice Address - Country:US
Practice Address - Phone:708-726-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC12032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional