Provider Demographics
NPI:1447909981
Name:MOORE, AKELAH (LCPC)
Entity type:Individual
Prefix:
First Name:AKELAH
Middle Name:
Last Name:MOORE
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 1:915 W CARMEN AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3242
Mailing Address - Country:US
Mailing Address - Phone:856-412-1211
Mailing Address - Fax:
Practice Address - Street 1:4607 N SHERIDAN RD APT 701
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6562
Practice Address - Country:US
Practice Address - Phone:856-412-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017264101YP2500X
IL180.05032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional