Provider Demographics
NPI:1952040743
Name:PECENICA, NICHOLAS DANIEL (CADAC II)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DANIEL
Last Name:PECENICA
Suffix:
Gender:M
Credentials:CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11175 PR 900 W
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47868
Mailing Address - Country:US
Mailing Address - Phone:219-613-8620
Mailing Address - Fax:
Practice Address - Street 1:1141 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3721
Practice Address - Country:US
Practice Address - Phone:812-558-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-51280101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)