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General NPI Number Information
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NPI Number | 1952612145
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Entity Type | Individual
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Provider Name | CHANDRA DOCKERY M.A.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 4314 S COTTAGE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60653-3514
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Country | US
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Telephone | 773-350-3749
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Fax |
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Provider Business Mailing Address
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Address Line | 12538 S YALE AVE
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City | CHICAGO
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State | IL
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Zip | 60628-7235
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Country | US
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Telephone | 773-350-3749
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180006574
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178002284
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License Number State | IL
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