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General NPI Number Information
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NPI Number | 1720611197
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Entity Type | Individual
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Provider Name | ALISSA ANN EDGE MA, LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1227 W SCHOOL ST
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City | CHICAGO
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State | IL
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Zip | 60657-1425
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Country | US
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Telephone | 937-477-7545
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Fax |
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Provider Business Mailing Address
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Address Line | 640 N LA SALLE DR STE 275
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City | CHICAGO
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State | IL
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Zip | 60654-3754
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Country | US
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Telephone | 937-477-7545
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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 | 180014512
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License Number State | IL
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