Provider Demographics
NPI:1275921280
Name:MOORE, DESTINEE SHARAE (LCSW)
Entity Type:Individual
Prefix:
First Name:DESTINEE
Middle Name:SHARAE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S MICHIGAN AVE UNIT 161
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2408
Mailing Address - Country:US
Mailing Address - Phone:312-521-0167
Mailing Address - Fax:708-843-9384
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:STE 1025
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3756
Practice Address - Country:US
Practice Address - Phone:312-521-0167
Practice Address - Fax:708-843-9384
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-26
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490172311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical