Individual provider Active NPI

Stavroula Helen Caribacas-Rendas, LPC

  • Professional Counselor
  • St Charles, IL
National Provider Identifier
1043982028
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180016427 Issued in IL
Practice address
1120 E Main St Ste 201
St Charles, IL 60174-2287
Phone
(630) 377-6613
Fax
(630) 377-6225
NPI assigned
Sep 29, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 178016941 IL
Professional Counselor 101YP2500X 180016427 IL Primary

Addresses

Primary practice location

1120 E Main St Ste 201
St Charles, IL 60174-2287

Mailing address

1120 E Main St Ste 201
St Charles, IL 60174-2287
Phone (630) 377-6613

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
178016941ILMDMental Health Counselor
180016427ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Centennial Counseling Center, PC Mental Health CurrentSince Oct 5, 2021 Accepting new patients

Locations

1120 E Main St
Ste 201
St Charles, IL 60174
Phone (630) 377-6613

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1043982028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST STE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E MAIN ST STE 201",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742287",
            "telephone_number": "630-377-6613",
            "fax_number": "630-377-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARIBACAS-RENDAS",
        "first_name": "STAVROULA",
        "middle_name": "HELEN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178016941",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180016427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.