Provider Demographics
NPI:1033766886
Name:NUCUP, MICHELLE (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NUCUP
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-8090
Mailing Address - Country:US
Mailing Address - Phone:773-506-4283
Mailing Address - Fax:773-506-4847
Practice Address - Street 1:845 W WILSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-8090
Practice Address - Country:US
Practice Address - Phone:773-506-4283
Practice Address - Fax:773-506-4847
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional