Provider Demographics
NPI:1013033885
Name:MACDONALD, MARK CHARLES (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0007011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical