Active NPI
Adrienne Waters Main, LCPC
- Professional Counselor
- Park Ridge, IL
National Provider Identifier
1194330241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.003752
- Practice address
- 36 Main St Ste 107
Park Ridge, IL 60068-4059 - Phone
- (847) 220-7298
- NPI assigned
- Sep 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.003752 | IL | Primary |
Addresses
Primary practice location
36 Main St Ste 107
Park Ridge, IL 60068-4059
Mailing address
304 S Home Ave
Park Ridge, IL 60068-3845
Phone (847) 636-8208
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
| License | State | Type | Specialty |
|---|---|---|---|
| 180.003752 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600041600000",
"number": "1194330241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 S HOME AVE",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600683845",
"telephone_number": "847-636-8208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36 MAIN ST STE 107",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600684059",
"telephone_number": "847-220-7298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAIN",
"first_name": "ADRIENNE",
"middle_name": "WATERS",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-14",
"last_updated": "2020-09-14",
"certification_date": "2020-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.003752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.