Provider Demographics
NPI:1043701550
Name:FORNEY, DEVON SIMONE (MA, LCPC, CAADC, NCC)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:SIMONE
Last Name:FORNEY
Suffix:
Gender:F
Credentials:MA, LCPC, CAADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 S MICHIGAN AVE APT 3606
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2323
Mailing Address - Country:US
Mailing Address - Phone:843-263-7733
Mailing Address - Fax:
Practice Address - Street 1:1130 S MICHIGAN AVE APT 3606
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2323
Practice Address - Country:US
Practice Address - Phone:843-263-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL37769101YA0400X
NC13837101YP2500X
IL180.015985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)