Provider Demographics
NPI:1881914125
Name:SOURELIS-SMITH, GINA ALEXANDRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:ALEXANDRA
Last Name:SOURELIS-SMITH
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 1:676 N SAINT CLAIR ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2954
Mailing Address - Country:US
Mailing Address - Phone:312-695-5060
Mailing Address - Fax:312-695-5010
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2954
Practice Address - Country:US
Practice Address - Phone:312-695-5060
Practice Address - Fax:312-695-5010
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0129231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical