Healthcare Provider Details

I. General information

NPI: 1013621523
Provider Name (Legal Business Name): 247DCT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 N WOOD DALE RD # 201A
WOOD DALE IL
60191-1578
US

IV. Provider business mailing address

343 N WOOD DALE RD # 201A
WOOD DALE IL
60191-1578
US

V. Phone/Fax

Practice location:
  • Phone: 773-817-5928
  • Fax:
Mailing address:
  • Phone: 773-817-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: WAJAHATUDDIN MACCI
Title or Position: OWNER
Credential:
Phone: 773-817-5928