Provider Demographics
NPI:1730434945
Name:WITVOET, PATRICIA (LCPC, NCC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WITVOET
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-8592
Mailing Address - Country:US
Mailing Address - Phone:708-793-0840
Mailing Address - Fax:
Practice Address - Street 1:15020 S RAVINIA AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3166
Practice Address - Country:US
Practice Address - Phone:708-793-0840
Practice Address - Fax:844-798-8931
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional