Provider Demographics
NPI:1598905846
Name:HAGENE, AYSHA ALI (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:AYSHA
Middle Name:ALI
Last Name:HAGENE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 N SEELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1313
Mailing Address - Country:US
Mailing Address - Phone:773-966-9363
Mailing Address - Fax:
Practice Address - Street 1:1557 SHERMAN AVE
Practice Address - Street 2:#1
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4836
Practice Address - Country:US
Practice Address - Phone:773-966-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18000697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional