Provider Demographics
NPI:1780129536
Name:MARIC, LATRICE ANNETTE (PHD, LCPC)
Entity type:Individual
Prefix:
First Name:LATRICE
Middle Name:ANNETTE
Last Name:MARIC
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:LATRICE
Other - Middle Name:ANNETTE
Other - Last Name:DRAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:845 N KINGSBURY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-9241
Mailing Address - Country:US
Mailing Address - Phone:312-796-7086
Mailing Address - Fax:
Practice Address - Street 1:1 E ERIE ST STE 520
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2792
Practice Address - Country:US
Practice Address - Phone:630-428-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180015221101YP2500X
IL178010329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional