Provider Demographics
NPI:1972841708
Name:ENOCH, KEARA ZANETA (LCPC, CADC, MAATP)
Entity Type:Individual
Prefix:MISS
First Name:KEARA
Middle Name:ZANETA
Last Name:ENOCH
Suffix:
Gender:F
Credentials:LCPC, CADC, MAATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 W 25TH ST # 269
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1409
Mailing Address - Country:US
Mailing Address - Phone:872-356-6466
Mailing Address - Fax:
Practice Address - Street 1:1 WESTBROOK CORPORATE CTR STE 300
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5709
Practice Address - Country:US
Practice Address - Phone:872-356-6466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL29332101YA0400X
IL180.009782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)