Provider Demographics
NPI:1972203693
Name:LIDDICOATT, LINDSEY SUE (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:SUE
Last Name:LIDDICOATT
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-3019
Mailing Address - Country:US
Mailing Address - Phone:847-507-0722
Mailing Address - Fax:
Practice Address - Street 1:201 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1960
Practice Address - Country:US
Practice Address - Phone:847-507-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL31109101YA0400X
IL180.016040101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)