Healthcare Provider Details

I. General information

NPI: 1043074057
Provider Name (Legal Business Name): ADULT THERAPY ALLIANCE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 E GENEVA RD
WHEATON IL
60187-2816
US

IV. Provider business mailing address

1005 APPLE CT
AURORA IL
60505-1456
US

V. Phone/Fax

Practice location:
  • Phone: 630-246-2944
  • Fax:
Mailing address:
  • Phone: 630-386-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VINCENT DHAN
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW, CADC
Phone: 630-386-5001