Individual
CARLOS IVAN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA,CRC,CADC,LPC
Contact information
Practice address
820 S DAMEN AVE, CHICAGO, IL 60612-3728
(312) 569-8387
Mailing address
820 S DAMEN AVE, CHICAGO, IL 60612-3728
(312) 569-8387
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17591
IL
101YP2500X
Professional Counselor
178.018669
IL
225C00000X
Rehabilitation Counselor
Primary
397297
IL
Other
Enumeration date
11/21/2023
Last updated
11/28/2023
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