Healthcare Provider Details

I. General information

NPI: 1619487956
Provider Name (Legal Business Name): ABBEY STOREY GATELY CRC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBEY DAVIS STOREY

II. Dates (important events)

Enumeration Date: 09/30/2017
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 N PINE GROVE AVE
CHICAGO IL
60614-6109
US

IV. Provider business mailing address

2921 N HALSTED ST APT 3F
CHICAGO IL
60657-5178
US

V. Phone/Fax

Practice location:
  • Phone: 312-259-2665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.013075
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00229815
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: