Provider Demographics
NPI:1760675854
Name:NEVINGER, JANE VICTORIA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:VICTORIA
Last Name:NEVINGER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:JANE
Other - Middle Name:VICTORIA
Other - Last Name:MCWILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17255 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60474-3401
Mailing Address - Country:US
Mailing Address - Phone:708-633-4533
Mailing Address - Fax:708-633-4531
Practice Address - Street 1:17255 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60474-3401
Practice Address - Country:US
Practice Address - Phone:708-633-4533
Practice Address - Fax:708-633-4531
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor