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Organization
PROVIDENCE COUNSELING ASSOCIATES, LLC
Active
Organization
PROVIDENCE COUNSELING ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE JOY SPACKEY PSY.D. (MANAGING MEMBER)
(630) 420-2596
Entity
Organization
Contact information
Practice address
445 W JACKSON AVE STE 206, NAPERVILLE, IL 60540-5258
(630) 420-2596
(630) 420-2796
Mailing address
445 W JACKSON AVE STE 206, NAPERVILLE, IL 60540-5258
(630) 420-2596
(630) 420-2796
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
103T00000X
Psychologist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0032240364
BLUECROSSBLUESHIELD
IL
Enumeration date
03/07/2007
Last updated
03/10/2009
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