Provider Demographics
NPI:1316149107
Name:MARK MACDONALD & ASSOCIATES, PC
Entity type:Organization
Organization Name:MARK MACDONALD & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRIVATE PRACTICE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-462-8810
Mailing Address - Street 1:600 W ROOSEVELT RD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5088
Mailing Address - Country:US
Mailing Address - Phone:630-462-8810
Mailing Address - Fax:630-462-8820
Practice Address - Street 1:600 W ROOSEVELT RD
Practice Address - Street 2:SUITE A2
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5088
Practice Address - Country:US
Practice Address - Phone:630-462-8810
Practice Address - Fax:630-462-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006320101YP2500X
IL180-005693101YP2500X
IL180-001600101YP2500X
IL149-0007011041C0700X
IL149-0033321041C0700X
IL149-0047251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty