Provider Demographics
NPI:1720387665
Name:CINNICK, DIANE L (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:CINNICK
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 CHADWICK WAY
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-5383
Mailing Address - Country:US
Mailing Address - Phone:847-609-1826
Mailing Address - Fax:847-949-7472
Practice Address - Street 1:430 MILWAUKEE AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3015
Practice Address - Country:US
Practice Address - Phone:847-609-1826
Practice Address - Fax:847-949-7472
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23515101YA0400X
IL180.007612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)