Provider Demographics
NPI:1811016009
Name:MCCORD, DOMONIQUE FRANCES (M A)
Entity Type:Individual
Prefix:
First Name:DOMONIQUE
Middle Name:FRANCES
Last Name:MCCORD
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S MICHIGAN AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2859
Mailing Address - Country:US
Mailing Address - Phone:312-371-1928
Mailing Address - Fax:312-371-1951
Practice Address - Street 1:2600 S MICHIGAN AVE STE 211
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:773-234-9355
Practice Address - Fax:773-321-9560
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490125391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical