Provider Demographics
NPI:1881478758
Name:GOODNICK, VIKI (LCPC)
Entity type:Individual
Prefix:
First Name:VIKI
Middle Name:
Last Name:GOODNICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W SOUTH 4TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278-2201
Mailing Address - Country:US
Mailing Address - Phone:618-282-7228
Mailing Address - Fax:
Practice Address - Street 1:500 W SOUTH 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-2201
Practice Address - Country:US
Practice Address - Phone:618-282-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004969101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional