Provider Demographics
NPI:1235470568
Name:DW ENTERPRISES LLC
Entity Type:Organization
Organization Name:DW ENTERPRISES LLC
Other - Org Name:HICKORY CREEK COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOLIGST / D
Authorized Official - Prefix:DR
Authorized Official - First Name:DORA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-462-3827
Mailing Address - Street 1:331 ALANA DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1766
Mailing Address - Country:US
Mailing Address - Phone:815-462-3827
Mailing Address - Fax:
Practice Address - Street 1:331 ALANA DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1766
Practice Address - Country:US
Practice Address - Phone:815-462-3827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006506103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty