Provider Demographics
NPI:1083883870
Name:D'AMICO, TERRY LEE (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:D'AMICO
Other - Middle Name:& ASSOCIATES IN
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12105 MEADOWLAND DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7832
Mailing Address - Country:US
Mailing Address - Phone:708-301-6311
Mailing Address - Fax:408-228-0891
Practice Address - Street 1:15750 S BELL RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8412
Practice Address - Country:US
Practice Address - Phone:708-301-6311
Practice Address - Fax:408-228-0891
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional