Provider Demographics
NPI:1619276243
Name:NOVINSKA, ANDREW PETER (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:PETER
Last Name:NOVINSKA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BEECH STREET
Mailing Address - Street 2:NORMANDY VILLAGE, SUITE #7
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761
Mailing Address - Country:US
Mailing Address - Phone:309-660-2900
Mailing Address - Fax:
Practice Address - Street 1:1100 BEECH ST
Practice Address - Street 2:NORMANDY VILLAGE #7
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1493
Practice Address - Country:US
Practice Address - Phone:309-660-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004180101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health