Provider Demographics
NPI:1447623194
Name:SOLTAU, GEORGIA (LCPC)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:SOLTAU
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 1:20200 GOVERNORS DR STE 201E
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1056
Mailing Address - Country:US
Mailing Address - Phone:872-205-6710
Mailing Address - Fax:
Practice Address - Street 1:20200 GOVERNORS DR STE 201E
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1056
Practice Address - Country:US
Practice Address - Phone:872-205-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009870101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional