Provider Demographics
NPI:1235391814
Name:MOTLEY, CHARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHARIE
Middle Name:
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 NERGE RD
Mailing Address - Street 2:APT. 212
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3270
Mailing Address - Country:US
Mailing Address - Phone:773-368-0682
Mailing Address - Fax:847-352-3006
Practice Address - Street 1:1300 E IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-3204
Practice Address - Country:US
Practice Address - Phone:630-837-9000
Practice Address - Fax:630-837-2710
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical