Provider Demographics
NPI:1801223011
Name:MATIC, MONIQUE CANDACE (MA, LPC, LCPC, ATR)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:CANDACE
Last Name:MATIC
Suffix:
Gender:F
Credentials:MA, LPC, LCPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 W JACKSON BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3053
Mailing Address - Country:US
Mailing Address - Phone:312-229-7256
Mailing Address - Fax:
Practice Address - Street 1:820 W JACKSON BLVD STE 550
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3053
Practice Address - Country:US
Practice Address - Phone:312-229-7256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008741101YM0800X
WI5177-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801223011Medicaid