Provider Demographics
NPI:1518077395
Name:MALUGA, MARK J (LCPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:MALUGA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 RENAISSANCE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1471
Mailing Address - Country:US
Mailing Address - Phone:847-759-9110
Mailing Address - Fax:
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:847-759-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004149101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor