Provider Demographics
NPI:1588056766
Name:DAMORE, AUDREY (LCSW, CADC)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:DAMORE
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-8631
Mailing Address - Country:US
Mailing Address - Phone:612-741-1178
Mailing Address - Fax:
Practice Address - Street 1:3809 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-8631
Practice Address - Country:US
Practice Address - Phone:612-741-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0201821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical