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General NPI Number Information
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NPI Number | 1568576106
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Entity Type | Individual
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Provider Name | TERRANCE S. MC NICHOLAS L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE SUITE 1604
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 312-629-0018
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Fax | 312-629-1178
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Provider Business Mailing Address
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Address Line | 30 N MICHIGAN AVE SUITE 1604
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 312-629-0018
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Fax | 312-629-1178
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149008023
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149008023
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License Number State | IL
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