Provider Demographics
NPI:1396307625
Name:LAMARCA, NICOLE (QMHP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LAMARCA
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3465
Mailing Address - Country:US
Mailing Address - Phone:847-931-2340
Mailing Address - Fax:
Practice Address - Street 1:109 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3465
Practice Address - Country:US
Practice Address - Phone:847-931-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health