Healthcare Provider Details

I. General information

NPI: 1073167490
Provider Name (Legal Business Name): NICOLE DIONNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N MICHIGAN AVE STE 1430
CHICAGO IL
60601-7653
US

IV. Provider business mailing address

PO BOX 1252
SPARTANBURG SC
29304-1252
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-6780
  • Fax: 312-261-5080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7143
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7863
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: