Provider Demographics
NPI:1851640973
Name:CHIN, ALICIA (LCPC, BCBA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:LCPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 62ND CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1818
Mailing Address - Country:US
Mailing Address - Phone:312-519-5865
Mailing Address - Fax:
Practice Address - Street 1:1040 62ND CT
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1818
Practice Address - Country:US
Practice Address - Phone:312-519-5865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional