Healthcare Provider Details

I. General information

NPI: 1093220865
Provider Name (Legal Business Name): SARAH ELIZABETH ARDEN DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2017
Last Update Date: 12/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2357 HASSELL RD STE 202
HOFFMAN ESTATES IL
60169-2172
US

IV. Provider business mailing address

2357 HASSELL RD STE 202
HOFFMAN ESTATES IL
60169-2172
US

V. Phone/Fax

Practice location:
  • Phone: 847-466-7775
  • Fax:
Mailing address:
  • Phone: 847-863-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.019876
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number149.019876
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number149.019876
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.019876
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: