Provider Demographics
NPI:1164016986
Name:ELAGINA, ANNA (LCPC, NCC, CADC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ELAGINA
Suffix:
Gender:F
Credentials:LCPC, NCC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2518
Mailing Address - Country:US
Mailing Address - Phone:872-760-4353
Mailing Address - Fax:
Practice Address - Street 1:404 W BOUGHTON RD STE A
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1898
Practice Address - Country:US
Practice Address - Phone:872-760-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty