Provider Demographics
NPI:1487262358
Name:LENOIR, CHLOE
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:LENOIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 S ILLINOIS AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-5988
Mailing Address - Country:US
Mailing Address - Phone:708-288-6332
Mailing Address - Fax:
Practice Address - Street 1:2310 S ILLINOIS AVE APT B3
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62903-5988
Practice Address - Country:US
Practice Address - Phone:708-288-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty