Doctor Name: | ALYSON GENELL MARSALIS |
NPI Number: | 1104928688 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | |
Business Practice Address: | 2634 Grand Ave Suite 107 Waukegan, IL - 600852458 |
Business Phone Number: | 8472493510 |
Business Fax Number: | 8472493823 |
Mailing Address: | 2634 Grand Ave, Suite 107 WAUKEGAN |
State: | IL |
Postal Code: | 600852458 |
Phone Number: | 8472493510 |
Fax Number: | 8472493823 |
NPI Enumeration Date: | 09/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |