Provider Demographics
NPI:1730649211
Name:WEISS, CHARLES (LPC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3208
Mailing Address - Country:US
Mailing Address - Phone:312-725-3093
Mailing Address - Fax:773-989-7207
Practice Address - Street 1:708 CHURCH ST STE 247
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3840
Practice Address - Country:US
Practice Address - Phone:414-454-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional