Healthcare Provider Details

I. General information

NPI: 1023946068
Provider Name (Legal Business Name): MARINA ALEXANDRA AWES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13850 W CAPITOL DR
BROOKFIELD WI
53005-2422
US

IV. Provider business mailing address

13850 W CAPITOL DR
BROOKFIELD WI
53005-2422
US

V. Phone/Fax

Practice location:
  • Phone: 414-293-3918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12324-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: