Provider Demographics
NPI:1720962079
Name:LONDON WELLNESS FOUNDATION
Entity type:Organization
Organization Name:LONDON WELLNESS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC, DBH
Authorized Official - Phone:312-848-1534
Mailing Address - Street 1:405 W SUPERIOR ST FL 7
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8559
Mailing Address - Country:US
Mailing Address - Phone:312-848-1534
Mailing Address - Fax:
Practice Address - Street 1:405 W SUPERIOR ST FL 7
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8559
Practice Address - Country:US
Practice Address - Phone:312-848-1534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)