Provider Demographics
NPI:1215412846
Name:RIPLEY, CARLA MARIE MARQUEZ (LCPC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE MARQUEZ
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BELLER RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4605
Mailing Address - Country:US
Mailing Address - Phone:630-973-7451
Mailing Address - Fax:
Practice Address - Street 1:4745 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1758
Practice Address - Country:US
Practice Address - Phone:630-973-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health