Provider Demographics
NPI:1538870480
Name:THORSEN, MARCIA (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:
Last Name:THORSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8767 N 1100TH ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-5916
Mailing Address - Country:US
Mailing Address - Phone:912-423-0453
Mailing Address - Fax:
Practice Address - Street 1:108 S GARFIELD ST
Practice Address - Street 2:
Practice Address - City:OBLONG
Practice Address - State:IL
Practice Address - Zip Code:62449-1464
Practice Address - Country:US
Practice Address - Phone:618-769-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health