Provider Demographics
NPI:1790222081
Name:MALO, DANICA JENICE CORANEZ (LPC)
Entity Type:Individual
Prefix:
First Name:DANICA JENICE
Middle Name:CORANEZ
Last Name:MALO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10188 W TALMADGE AVE
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3867
Mailing Address - Country:US
Mailing Address - Phone:847-707-3383
Mailing Address - Fax:
Practice Address - Street 1:10188 W TALMADGE AVE
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60099-3867
Practice Address - Country:US
Practice Address - Phone:847-707-3383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL178.016743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor