Provider Demographics
NPI:1447435128
Name:MAGEE, SUSAN R (LCPC, CADC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:MAGEE
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8631
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-7018
Mailing Address - Country:US
Mailing Address - Phone:847-826-1569
Mailing Address - Fax:
Practice Address - Street 1:34930 N HIGHWAY 45
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-7537
Practice Address - Country:US
Practice Address - Phone:847-826-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20331101YA0400X
IL180.005019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)