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General NPI Number Information
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NPI Number | 1720387665
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Entity Type | Individual
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Provider Name | DIANE L CINNICK LCPC, CADC
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Gender | Female
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Dates
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Enumeration Date | 03/17/2011
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 430 MILWAUKEE AVE SUITE 15
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3015
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Country | US
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Telephone | 847-609-1826
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Fax | 847-949-7472
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Provider Business Mailing Address
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Address Line | 2160 CHADWICK WAY
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City | MUNDELEIN
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State | IL
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Zip | 60060-5383
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Country | US
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Telephone | 847-609-1826
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Fax | 847-949-7472
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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 | 23515
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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 | 180.007612
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License Number State | IL
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