Provider Demographics
NPI:1003319146
Name:HEADLEY, PHYLICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 N KENNICOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7814
Mailing Address - Country:US
Mailing Address - Phone:847-952-7460
Mailing Address - Fax:847-222-1754
Practice Address - Street 1:3436 N KENNICOTT AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7814
Practice Address - Country:US
Practice Address - Phone:847-952-7460
Practice Address - Fax:847-222-1754
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490234191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical