Provider Demographics
NPI:1104928688
Name:MARSALIS, ALYSON GENELL (LCPC)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:GENELL
Last Name:MARSALIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2634 GRAND AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2458
Mailing Address - Country:US
Mailing Address - Phone:847-249-3510
Mailing Address - Fax:847-249-3823
Practice Address - Street 1:2634 GRAND AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2458
Practice Address - Country:US
Practice Address - Phone:847-249-3510
Practice Address - Fax:847-249-3823
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health