Individual
CHAD DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
625 WHAM DR, ROOM 141, CARBONDALE, IL 62901-4313
(618) 453-2361
(618) 453-6130
Mailing address
625 WHAM DR, ROOM 141, CARBONDALE, IL 62901-4313
(618) 453-2361
(618) 453-6130
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071008612
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
071008612
DEPT. OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
11/17/2015
Last updated
11/17/2015
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