Provider Demographics
NPI:1134516370
Name:MARKOVICH, NICHOLAS (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MARKOVICH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 18TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8720
Mailing Address - Country:US
Mailing Address - Phone:309-283-7361
Mailing Address - Fax:309-283-7362
Practice Address - Street 1:208 18TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8720
Practice Address - Country:US
Practice Address - Phone:309-283-7361
Practice Address - Fax:309-283-7362
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490175011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical