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Organization
247DCT
Active
Organization
247DCT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAJAHATUDDIN MACCI (CFO)
(773) 817-5928
Entity
Organization
Contact information
Practice address
343 N WOOD DALE RD STE 201, WOOD DALE, IL 60191-1565
(773) 322-9581
Mailing address
343 N WOOD DALE RD, WOOD DALE, IL 60191-1578
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103T00000X
Psychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TE1100X
Exercise & Sports Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TF0200X
Forensic Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
06/27/2022
Last updated
06/27/2022
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