Demetria Agharese, MA, LPC
Individual provider Active NPI Professional Counselor · Roselle, IL
NPI 1669916565 · NPPES record last updated Oct 18, 2023
Key facts
- NPI
- 1669916565
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 6401013625 (MI)
- Practice address
- 286 Regal CT
Roselle, IL 60172-4714 - Phone
- (313) 377-7456
- NPI assigned
- Dec 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2012
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
PO Box
Dallas, TX 75373
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (6 enrollments) in MI, CO, OH, FL, CT, GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250103001650 | MI | Practitioner - Mental Health Counselor | 0446788459 | Reassigns benefits to 1 organization |
| I20250107000989 | CO | Practitioner - Mental Health Counselor | 0446788459 | Reassigns benefits to 1 organization |
| I20250115002369 | OH | Practitioner - Mental Health Counselor | 0446788459 | Reassigns benefits to 1 organization |
| I20250423003593 | FL | Practitioner - Mental Health Counselor | 0446788459 | Reassigns benefits to 1 organization |
| I20250430000222 | CT | Practitioner - Mental Health Counselor | 0446788459 | Reassigns benefits to 1 organization |
| I20251230003352 | GA | Practitioner - Mental Health Counselor | 0446788459 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401013625 | MI | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Mental Health | Current |
Accepting new patients |
| Nocd Florida Behavioral Health P.a. | Mental Health | Past | Accepting new patients |
Locations
5445 Dtc Pkwy
Ph 4
Greenwood Village, CO 80111
Phone (720) 571-4874
100 Pearl St
Fl 14
Hartford, CT 06103
Phone (860) 421-6636
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
715 Peachtree St NE
Ste 100
Atlanta, GA 30308
Phone (202) 972-4964
250 Monroe Ave NW
Ste 400
Grand Rapids, MI 49503
Phone (616) 441-4616
4449 Easton Way
Fl 2
Columbus, OH 43219
Phone (614) 565-8197
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 6401013625 | MI | |
| Mental Health Counselor | 101YM0800X | 6401013625 | MI | |
| Professional Counselor | 101YP2500X | 6401013625 | MI | Yes |
Addresses
Primary practice location
286 Regal CT
Roselle, IL 60172-4714
Mailing address
286 Regal CT
Roselle, IL 60172-4714
Phone (313) 377-7456
Other providers in Roselle, IL
- Advanced Health Solutions Inc
- Advanced Physical Medicine Associates SC
- Advantage Chiropractic
- Advocate Wellness LLC.
- Afp Podiatry LTD
- Tariq Ahmed
- Angela Albrigo
- Alpha Medical Imaging, LLC
- Lisa Marie Alt
- Amani Senior Care Incorporated
All providers in Roselle, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.