Individual
DEREK RAYMOND MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
800 ROOSEVELT RD STE 206, GLEN ELLYN, IL 60137-5839
(630) 423-5935
Mailing address
8020 W 87TH ST, HICKORY HILLS, IL 60457-1189
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
34385
IL
101YM0800X
Mental Health Counselor
Primary
178017617
IL
Other
Enumeration date
10/03/2018
Last updated
06/24/2022
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