Provider Demographics
NPI:1043982028
Name:CARIBACAS-RENDAS, STAVROULA HELEN (LPC)
Entity type:Individual
Prefix:
First Name:STAVROULA
Middle Name:HELEN
Last Name:CARIBACAS-RENDAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2287
Mailing Address - Country:US
Mailing Address - Phone:630-377-6613
Mailing Address - Fax:630-377-6225
Practice Address - Street 1:1120 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2287
Practice Address - Country:US
Practice Address - Phone:630-377-6613
Practice Address - Fax:630-377-6225
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016941101YM0800X
IL180016427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health