Provider Demographics
NPI:1871961276
Name:STAVROPLOS, KRISTINA (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:STAVROPLOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:STAVROPLOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:9941 TREETOP DR APT 3201
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5398
Mailing Address - Country:US
Mailing Address - Phone:708-296-3845
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD STE 246
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-3038
Practice Address - Country:US
Practice Address - Phone:708-296-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490197291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical