Provider Demographics
NPI:1255731121
Name:STOREY, LINDORIA C (MSW,LCSW, CPAIP, PHD)
Entity type:Individual
Prefix:DR
First Name:LINDORIA
Middle Name:C
Last Name:STOREY
Suffix:
Gender:F
Credentials:MSW,LCSW, CPAIP, PHD
Other - Prefix:
Other - First Name:LINDORIA
Other - Middle Name:C
Other - Last Name:ROLLINS- STOREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW, LISW-CP
Mailing Address - Street 1:23831 S KURT LN
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1737
Mailing Address - Country:US
Mailing Address - Phone:312-898-7358
Mailing Address - Fax:312-444-0793
Practice Address - Street 1:9510 S CONSTANCE AVE STE C-6
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4700
Practice Address - Country:US
Practice Address - Phone:312-898-7358
Practice Address - Fax:312-444-0793
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490169431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL32264980201Medicaid