Provider Demographics
NPI:1447511951
Name:DFM WELLNESS ALLIANCE, LLC
Entity type:Organization
Organization Name:DFM WELLNESS ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:FRSNCES
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:773-234-9355
Mailing Address - Street 1:2600 S MICHIGAN AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2859
Mailing Address - Country:US
Mailing Address - Phone:773-234-9355
Mailing Address - Fax:773-321-9560
Practice Address - Street 1:2600 S MICHIGAN AVE STE 211
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2859
Practice Address - Country:US
Practice Address - Phone:773-234-9355
Practice Address - Fax:773-321-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490125391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty