Provider Demographics
NPI:1548797681
Name:FAUL, CHASITY D (LCPC)
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:D
Last Name:FAUL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CHASITY
Other - Middle Name:D
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 HENRY ST STE 401
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6326
Mailing Address - Country:US
Mailing Address - Phone:618-465-9747
Mailing Address - Fax:
Practice Address - Street 1:307 HENRY ST STE 401
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6326
Practice Address - Country:US
Practice Address - Phone:618-465-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional