Provider Demographics
NPI:1568576106
Name:MC NICHOLAS, TERRANCE S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:S
Last Name:MC NICHOLAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1604
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-629-0018
Mailing Address - Fax:312-629-1178
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1604
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-629-0018
Practice Address - Fax:312-629-1178
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490080231041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health