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General NPI Number Information
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NPI Number | 1659883973
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Entity Type | Individual
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Provider Name | GRACIE A BATES-DAVIS LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 333 S WABASH AVE STE 2700
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City | CHICAGO
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State | IL
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Zip | 60604-4129
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Country | US
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Telephone | 312-809-6984
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Fax |
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Provider Business Mailing Address
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Address Line | 333 S WABASH AVE STE 2700
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City | CHICAGO
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State | IL
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Zip | 60604-4129
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180009958
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License Number State | IL
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