| Doctor Name: | NICOLE ANTOINETTE SHIELDS |
| NPI Number: | 1023104940 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, LCPC, QMHP |
| License Number: | |
| Business Practice Address: | 1025 Maine St Quincy, IL - 623014038 |
| Business Phone Number: | 2172226550 |
| Business Fax Number: | |
| Mailing Address: | 2633 Brook Drive, QUINCY |
| State: | IL |
| Postal Code: | 62301 |
| Phone Number: | 2172230413 |
| Fax Number: | |
| NPI Enumeration Date: | 10/05/2006 |
| NPI Last Update Date: | 05/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |