Provider Demographics
NPI:1265780803
Name:BLOCK, DEVON MICHELLE (LCPC)
Entity type:Individual
Prefix:MS
First Name:DEVON
Middle Name:MICHELLE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 ELM ST
Mailing Address - Street 2:APT 6J
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4292
Mailing Address - Country:US
Mailing Address - Phone:847-707-9792
Mailing Address - Fax:
Practice Address - Street 1:1237 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6817
Practice Address - Country:US
Practice Address - Phone:847-707-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009538101YP2500X
IL178006625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional