Provider Demographics
NPI:1710754247
Name:HIGHLEY-LANE, DELORES D (CADC, BA)
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:D
Last Name:HIGHLEY-LANE
Suffix:
Gender:F
Credentials:CADC, BA
Other - Prefix:
Other - First Name:DELORES
Other - Middle Name:D
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC, BA
Mailing Address - Street 1:7303 S MARYLANDN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-1919
Mailing Address - Country:US
Mailing Address - Phone:872-818-6038
Mailing Address - Fax:
Practice Address - Street 1:7303 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1919
Practice Address - Country:US
Practice Address - Phone:872-818-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL28128101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)