Provider Demographics
NPI:1871797613
Name:PERSUN, NADIA (LCPC)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:PERSUN
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 1:2132 DEEP WATER LN
Mailing Address - Street 2:STE 240
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8565
Mailing Address - Country:US
Mailing Address - Phone:630-217-9911
Mailing Address - Fax:630-596-8636
Practice Address - Street 1:2132 DEEP WATER LN
Practice Address - Street 2:STE 240
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8565
Practice Address - Country:US
Practice Address - Phone:630-217-9911
Practice Address - Fax:630-596-8636
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional