Individual
GVANTSA IVANISHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
215 HARRISON ST, OAK PARK, IL 60304-1533
(708) 628-8000
Mailing address
215 HARRISON ST, OAK PARK, IL 60304-1533
(708) 628-8000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
178022792
IL
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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