Provider Demographics
NPI:1871767806
Name:VANDARAKIS, DIMITRIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DIMITRIA
Middle Name:
Last Name:VANDARAKIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 MAIN ST
Mailing Address - Street 2:STE 103L
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-890-9895
Mailing Address - Fax:630-620-6194
Practice Address - Street 1:5120 MAIN ST
Practice Address - Street 2:STE 103L
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-890-9895
Practice Address - Fax:630-620-6194
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490126341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical