Provider Demographics
NPI:1740681527
Name:TOMACIC, CHRISTINA (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:TOMACIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 N KEDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5207
Mailing Address - Country:US
Mailing Address - Phone:773-793-9284
Mailing Address - Fax:
Practice Address - Street 1:1731 N MARCEY ST STE 535
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-7965
Practice Address - Country:US
Practice Address - Phone:312-280-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149010495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional