Provider Demographics
NPI:1548006521
Name:SMITH, DONNAVIEVE NICOLE (LCPC)
Entity type:Individual
Prefix:
First Name:DONNAVIEVE
Middle Name:NICOLE
Last Name:SMITH
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 1:1525 S MICHIGAN AVE APT 211
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-4821
Mailing Address - Country:US
Mailing Address - Phone:773-719-9550
Mailing Address - Fax:
Practice Address - Street 1:1525 S MICHIGAN AVE APT 211
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-4821
Practice Address - Country:US
Practice Address - Phone:773-719-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180016190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty