Healthcare Provider Details

I. General information

NPI: 1841643491
Provider Name (Legal Business Name): TERESA DAVIS-FEWKES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12627 W 143RD ST
HOMER GLEN IL
60491-8381
US

IV. Provider business mailing address

13021 S OAK CT
PALOS HEIGHTS IL
60463-1927
US

V. Phone/Fax

Practice location:
  • Phone: 708-203-3199
  • Fax:
Mailing address:
  • Phone: 708-361-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: