Provider Demographics
NPI:1669774535
Name:MCNICHOLL COUNSELING, P.C.
Entity type:Organization
Organization Name:MCNICHOLL COUNSELING, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCNICHOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-722-9079
Mailing Address - Street 1:201 W SPRINGFIELD AVE STE 1201
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6385
Mailing Address - Country:US
Mailing Address - Phone:217-722-9079
Mailing Address - Fax:217-501-4322
Practice Address - Street 1:201 W SPRINGFIELD AVE STE 1201
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6385
Practice Address - Country:US
Practice Address - Phone:217-722-9079
Practice Address - Fax:217-501-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty