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General NPI Number Information
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NPI Number | 1104288380
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Entity Type | Organization
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Legal Business Name | MARLA DAVIS HENRY LCSW
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 647 WICKLOW RD
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City | DEERFIELD
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State | IL
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Zip | 60015-4522
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Country | US
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Telephone | 847-471-3273
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Fax | 847-948-8742
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Provider Business Mailing Address
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Address Line | 647 WICKLOW RD
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City | DEERFIELD
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State | IL
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Zip | 60015-4522
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Country | US
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Telephone | 847-471-3273
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Fax | 847-948-8742
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MARLA ILENE DAVIS HENRY
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Credential | LCSW
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Telephone | 847-471-3273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149007033
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License Number State | IL
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