Provider Demographics
NPI:1881240240
Name:CARR, DELGRASHIEA SHALON (MCJ)
Entity type:Individual
Prefix:MS
First Name:DELGRASHIEA
Middle Name:SHALON
Last Name:CARR
Suffix:
Gender:F
Credentials:MCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 WILLOW LN APT C5
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-1462
Mailing Address - Country:US
Mailing Address - Phone:224-565-8159
Mailing Address - Fax:
Practice Address - Street 1:2905 WILLOW LN APT C5
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-1462
Practice Address - Country:US
Practice Address - Phone:224-565-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health