Organization · NPI-2

1402 Cockrell LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Springfield, IL

NPI number1184590747
StatusActive
Last updated in NPPESOct 13, 2025

Details

NPI
1184590747
Entity type
Organization (NPI-2)
Legal business name
1402 Cockrell LLC
Organization subpart
No
Enumeration date
Oct 13, 2025
Certification date
Oct 13, 2025
Last updated
Oct 13, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes
261QM0850X Clinic/Center, Adult Mental Health––
261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder––
251S00000X Community/Behavioral Health––

Other names

  • Duad Wellness (Doing Business As)

Practice location

4012 Cockrell Ln
Springfield, IL 62711-8327

Phone 847-324-3543

Mailing address

6317 N Monticello Ave
Chicago, IL 60659-1209

Phone 847-324-3543

Authorized official

Sariah Hopkins
Compliance Officer
8473243543

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

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