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General NPI Number Information
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NPI Number | 1215444906
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Entity Type | Individual
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Provider Name | MICHELLE DUDA MS, LCPC, CADC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 1041 N WESTERN AVE FL 1
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City | CHICAGO
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State | IL
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Zip | 60622-3571
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Country | US
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Telephone | 312-566-8417
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 N WESTERN AVE FL 1
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City | CHICAGO
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State | IL
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Zip | 60622-3571
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Country | US
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Telephone | 312-566-8417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 33720
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178011972
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180012359
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License Number State | IL
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