Provider Demographics
NPI:1639636566
Name:WICK, DANA (LCPC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:WICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14928 KILBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3234
Mailing Address - Country:US
Mailing Address - Phone:708-288-4057
Mailing Address - Fax:
Practice Address - Street 1:15915 S CRYSTAL CREEK DR STE E
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9381
Practice Address - Country:US
Practice Address - Phone:708-288-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
IL180-014539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional