Provider Demographics
NPI:1730956533
Name:GREEN, NIKOLE (LCPC)
Entity type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:GREEN
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 1:901 LAKE ST UNIT 3343
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60303-1069
Mailing Address - Country:US
Mailing Address - Phone:773-517-1889
Mailing Address - Fax:
Practice Address - Street 1:332 S MICHIGAN AVE STE 121
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4302
Practice Address - Country:US
Practice Address - Phone:773-517-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.016587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional