Provider Demographics
NPI:1821235201
Name:RUFFIN, NIKKI RENEE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:RENEE
Last Name:RUFFIN
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 1:3205 LONGWOOD LN
Mailing Address - Street 2:#209
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-7163
Mailing Address - Country:US
Mailing Address - Phone:630-800-1958
Mailing Address - Fax:
Practice Address - Street 1:3205 LONGWOOD LN
Practice Address - Street 2:#209
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-7163
Practice Address - Country:US
Practice Address - Phone:630-800-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional