Individual
MICHAEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1113 GREENWOOD AVE, WAUKEGAN, IL 60085
(847) 244-4434
Mailing address
4215 HICKORY HILLS DR # P, APT 111, WAUKEGAN, IL 60087-5318
(630) 370-2528
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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