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General NPI Number Information
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NPI Number | 1174445100
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Entity Type | Individual
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Provider Name | MS. MARISA NICOLE RUBALCAVA
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 175 E HAWTHORN PKWY STE 155
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City | VERNON HILLS
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State | IL
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Zip | 60061-1493
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Country | US
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Telephone | 847-792-5022
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Fax |
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Provider Business Mailing Address
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Address Line | 216 RUSSET WAY
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City | VERNON HILLS
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State | IL
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Zip | 60061-1922
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.032816
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License Number State | IL
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