Provider Demographics
NPI:1538490172
Name:MCNICHOLL, STACI LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:LEE
Last Name:MCNICHOLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3320
Mailing Address - Country:US
Mailing Address - Phone:217-373-1700
Mailing Address - Fax:217-373-1884
Practice Address - Street 1:809 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3320
Practice Address - Country:US
Practice Address - Phone:217-373-1700
Practice Address - Fax:217-373-1884
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical