Provider Demographics
NPI:1982830576
Name:ALFON, CARMEN ANGBETIC (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:ANGBETIC
Last Name:ALFON
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 1:292 N CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3835
Mailing Address - Country:US
Mailing Address - Phone:309-342-1136
Mailing Address - Fax:309-342-1891
Practice Address - Street 1:292 N CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3835
Practice Address - Country:US
Practice Address - Phone:309-342-1136
Practice Address - Fax:309-342-1891
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.004066OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION