Provider Demographics
NPI:1689933079
Name:AVALLONE, DANIELLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:AVALLONE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 ZEPPELIN DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5930
Mailing Address - Country:US
Mailing Address - Phone:912-704-5063
Mailing Address - Fax:
Practice Address - Street 1:1732 ZEPPELIN DR
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5930
Practice Address - Country:US
Practice Address - Phone:912-704-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional