Provider Demographics
NPI:1285745901
Name:AZZALINE, MICHAEL ROBERT (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:AZZALINE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
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Mailing Address - Street 1:15300 WEST AVE
Mailing Address - Street 2:SUITE 313
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4600
Mailing Address - Country:US
Mailing Address - Phone:708-460-2370
Mailing Address - Fax:708-226-2621
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:SUITE 313
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-460-2370
Practice Address - Fax:708-226-2621
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)