Provider Demographics
NPI:1780082248
Name:MUCHA, JOANNA GRACE (LCPC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:GRACE
Last Name:MUCHA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:GRACE
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4750 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7528
Mailing Address - Country:US
Mailing Address - Phone:773-751-4048
Mailing Address - Fax:773-751-4174
Practice Address - Street 1:4750 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7528
Practice Address - Country:US
Practice Address - Phone:773-751-4048
Practice Address - Fax:773-751-4174
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional