Provider Demographics
NPI:1093602500
Name:DE'TRAYON, DEMITRI (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:DEMITRI
Middle Name:
Last Name:DE'TRAYON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 S STATE ST APT 209
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2155
Mailing Address - Country:US
Mailing Address - Phone:773-474-9270
Mailing Address - Fax:
Practice Address - Street 1:2310 S STATE ST APT 209
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2155
Practice Address - Country:US
Practice Address - Phone:773-474-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional