Individual
DEIDRA DAME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
495 DEVONSHIRE DR, CHAMPAIGN, IL 61820-7295
(217) 904-3035
Mailing address
495 DEVONSHIRE DR, CHAMPAIGN, IL 61820-7295
(217) 904-3035
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
150113585
IL
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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