Provider Demographics
NPI:1891588323
Name:WASHINGTON, IVA BRENAE (LPC)
Entity type:Individual
Prefix:
First Name:IVA
Middle Name:BRENAE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 N KENMORE AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2745
Mailing Address - Country:US
Mailing Address - Phone:517-392-5321
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 603
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4586
Practice Address - Country:US
Practice Address - Phone:773-983-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health