Individual
CHARLOTTE J MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, CADC
Contact information
Practice address
5537 N BROADWAY ST, CHICAGO, IL 60640-1405
(773) 989-9400
(773) 989-9494
Mailing address
5537 N BROADWAY ST, CHICAGO, IL 60640-1405
(773) 989-9400
(773) 989-9494
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
17678
IL
101YM0800X
Mental Health Counselor
180.005476
IL
101YP2500X
Professional Counselor
Primary
180.005476
IL
Other
Enumeration date
03/14/2012
Last updated
03/14/2012
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