Individual
DENISE MARIE STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
140 N ASHLAND AVE, CHICAGO, IL 60607-1802
(312) 850-0050
(312) 850-9095
Mailing address
6334 S WINCHESTER AVE FL 2, CHICAGO, IL 60636-2614
(312) 850-0050
(312) 850-9095
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
30989
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568509719
—
IL
Enumeration date
12/29/2018
Last updated
12/29/2018
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