Individual
DE'SHACE SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5758 ELAINE DR STE 112, ROCKFORD, IL 61108-3102
(815) 975-1177
Mailing address
9840 S GENOA AVE, CHICAGO, IL 60643-1537
(773) 253-1546
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
Other
Enumeration date
08/28/2023
Last updated
08/28/2023
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