| Doctor Name: | MR. NICHOLAS JOSEPH SMITH |
| NPI Number: | 1003155656 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.P.C. |
| License Number: | 178.008678 |
| Business Practice Address: | 24020 W Riverwalk Ct Suite 100 Plainfield, IL - 605447103 |
| Business Phone Number: | 8155778970 |
| Business Fax Number: | |
| Mailing Address: | 555 Thornhill Dr, Apt. 214 CAROL STREAM |
| State: | IL |
| Postal Code: | 601882760 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/01/2013 |
| NPI Last Update Date: | 02/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 178.008678 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |