Provider Demographics
NPI:1033380787
Name:DAVIS, CHA-LOE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHA-LOE
Middle Name:
Last Name:DAVIS
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 1:3655 GABRIELLE LN
Mailing Address - Street 2:#1424
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7993
Mailing Address - Country:US
Mailing Address - Phone:630-898-0657
Mailing Address - Fax:
Practice Address - Street 1:132 E 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2302
Practice Address - Country:US
Practice Address - Phone:773-487-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0133851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical