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General NPI Number Information
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NPI Number | 1114738754
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Entity Type | Individual
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Provider Name | MELISSA MOORE CADC
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 1731 N MARCEY ST STE 520
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City | CHICAGO
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State | IL
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Zip | 60614-7048
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Country | US
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Telephone | 224-661-1958
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Fax |
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Provider Business Mailing Address
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Address Line | 40 SKOKIE BLVD STE 200
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City | NORTHBROOK
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State | IL
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Zip | 60062-1615
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Country | US
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Telephone | 224-661-1958
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 33141
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License Number State | IL
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