Provider Demographics
NPI:1962062190
Name:MARIN, ALYCIA DION (LPC)
Entity type:Individual
Prefix:
First Name:ALYCIA
Middle Name:DION
Last Name:MARIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALYCIA
Other - Middle Name:DION
Other - Last Name:RI'CHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3505 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2489
Mailing Address - Country:US
Mailing Address - Phone:414-431-4444
Mailing Address - Fax:
Practice Address - Street 1:3505 N 124TH ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2489
Practice Address - Country:US
Practice Address - Phone:414-431-4444
Practice Address - Fax:414-431-0858
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8098-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional