Provider Demographics
NPI:1053490235
Name:LEPAGE, GEORGETTE ELAINE (MS, LCPC)
Entity type:Individual
Prefix:MS
First Name:GEORGETTE
Middle Name:ELAINE
Last Name:LEPAGE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 N LAKE SHORE DRIVE, UNIT 3010
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5314
Mailing Address - Country:US
Mailing Address - Phone:708-373-1952
Mailing Address - Fax:847-675-7167
Practice Address - Street 1:3660 N LAKE SHORE DRIVE, UNIT 3010
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5314
Practice Address - Country:US
Practice Address - Phone:708-373-1952
Practice Address - Fax:847-675-7167
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626639OtherBLUE CROSS