=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972841708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEARA ZANETA ENOCH LCPC, CADC, MAATP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2013
-----------------------------------------------------
Last Update Date | 05/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 WESTBROOK CORPORATE CTR STE 300
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-5709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-356-6466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7301 W 25TH ST # 269
-----------------------------------------------------
City | NORTH RIVERSIDE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60546-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-356-6466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 29332
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 180.009782
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------