Provider Demographics
NPI:1780937193
Name:GILL, NICOLE (LCPC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1731 N MARCEY ST STE 535
Mailing Address - Street 2:TERRY HEFTER ASSOCIATES L.L.C.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7965
Mailing Address - Country:US
Mailing Address - Phone:312-280-1166
Mailing Address - Fax:
Practice Address - Street 1:1731 N MARCEY ST STE 535
Practice Address - Street 2:TERRY HEFTER ASSOCIATES L.L.C.
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:2012-10-23
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health