Provider Demographics
NPI:1275776882
Name:BAILEY, NICOLE M (LCPC, ATR, CADC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LCPC, ATR, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N ROCKWELL ST
Mailing Address - Street 2:APT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:312-623-3260
Mailing Address - Fax:
Practice Address - Street 1:633 ROGERS ST
Practice Address - Street 2:SUITE 111
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:312-623-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007162101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional