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General NPI Number Information
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NPI Number | 1811016009
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Entity Type | Individual
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Provider Name | DOMONIQUE FRANCES MCCORD M. A.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 2600 S MICHIGAN AVE STE 211
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 773-234-9355
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Fax | 773-321-9560
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Provider Business Mailing Address
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Address Line | 2600 S MICHIGAN AVE STE 211
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City | CHICAGO
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State | IL
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Zip | 60616-2859
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Country | US
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Telephone | 312-371-1928
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Fax | 312-371-1951
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149012539
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License Number State | IL
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