Provider Demographics
NPI:1528518149
Name:AGUILAR, ALEXIS (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28038 W HOMESTEAD CT
Mailing Address - Street 2:
Mailing Address - City:LAKEMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60051-6662
Mailing Address - Country:US
Mailing Address - Phone:847-508-6399
Mailing Address - Fax:
Practice Address - Street 1:118 S MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-1859
Practice Address - Country:US
Practice Address - Phone:847-508-6399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL33165101YA0400X
IL180013436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)