Provider Demographics
NPI:1609174192
Name:MASSEY-HASTINGS, NICOLE JUSTINE (PSYD, LCP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:JUSTINE
Last Name:MASSEY-HASTINGS
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:JUSTINE
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LCP
Mailing Address - Street 1:15 SPINNING WHEEL RD STE 116
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2983
Mailing Address - Country:US
Mailing Address - Phone:630-708-0362
Mailing Address - Fax:
Practice Address - Street 1:15 SPINNING WHEEL RD STE 116
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2983
Practice Address - Country:US
Practice Address - Phone:630-708-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008385101YM0800X
IL071008745103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health