Provider Demographics
NPI:1679723555
Name:REAGAN-VORASORN, MARY E (LCPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:REAGAN-VORASORN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11559 MILIENNIUM PKWY
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5184
Mailing Address - Country:US
Mailing Address - Phone:847-636-6544
Mailing Address - Fax:
Practice Address - Street 1:710 E OGDEN AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8602
Practice Address - Country:US
Practice Address - Phone:630-848-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4443101YA0400X
IL180004395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)