Provider Demographics
NPI:1407655996
Name:DUKA, NICHOLAS THOMAS (LPC, NCC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:THOMAS
Last Name:DUKA
Suffix:
Gender:
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 JOY DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-9589
Mailing Address - Country:US
Mailing Address - Phone:331-645-7860
Mailing Address - Fax:
Practice Address - Street 1:6845 WEAVER RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8051
Practice Address - Country:US
Practice Address - Phone:331-645-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.021393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty