=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386877660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D G COUNSELING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2009
-----------------------------------------------------
Last Update Date | 07/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 MAPLE AVE
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-353-0697
-----------------------------------------------------
Fax | 630-353-0697
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 MAPLE AVE
-----------------------------------------------------
City | DOWNERS GROVE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60515-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-353-0697
-----------------------------------------------------
Fax | 630-353-0697
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DONNA J GLUCK
-----------------------------------------------------
Credential | EDD, LCPC
-----------------------------------------------------
Telephone | 630-353-0697
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180-004746
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------