Provider Demographics
NPI:1861875452
Name:DE AZEVEDO, CAMILA OLIVEIRA (LCPC)
Entity type:Individual
Prefix:
First Name:CAMILA
Middle Name:OLIVEIRA
Last Name:DE AZEVEDO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CAMILA
Other - Middle Name:AZEVEDO
Other - Last Name:FELDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CT
Mailing Address - Street 1:1617 W FOSTER AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2013
Mailing Address - Country:US
Mailing Address - Phone:312-907-8552
Mailing Address - Fax:
Practice Address - Street 1:1617 W FOSTER AVE FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2013
Practice Address - Country:US
Practice Address - Phone:312-907-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500337-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health