Provider Demographics
NPI:1891827655
Name:DWB HUMAN SERVICES INC
Entity Type:Organization
Organization Name:DWB HUMAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-327-9356
Mailing Address - Street 1:4350 N HERMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1106
Mailing Address - Country:US
Mailing Address - Phone:773-327-9356
Mailing Address - Fax:773-348-8220
Practice Address - Street 1:4350 N HERMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1106
Practice Address - Country:US
Practice Address - Phone:773-327-9356
Practice Address - Fax:773-348-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006419261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632869OtherBCBS
IL01632869OtherBCBS