Provider Demographics
NPI:1407289887
Name:MAGIDA, MICHELLE (LCPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MAGIDA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:POMERANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBS1
Mailing Address - Street 1:1217 MCHENRY RD STE 236
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1379
Mailing Address - Country:US
Mailing Address - Phone:847-807-8777
Mailing Address - Fax:
Practice Address - Street 1:1217 MCHENRY RD STE 236
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1379
Practice Address - Country:US
Practice Address - Phone:847-807-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010603101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health