Provider Demographics
NPI:1275040602
Name:SYDNOR DAVIS, CONSWAILA (LCPC)
Entity Type:Individual
Prefix:
First Name:CONSWAILA
Middle Name:
Last Name:SYDNOR DAVIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6531 S INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-4203
Mailing Address - Country:US
Mailing Address - Phone:773-841-3112
Mailing Address - Fax:
Practice Address - Street 1:1525 E 55TH STREET
Practice Address - Street 2:SUITE 301-B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5581
Practice Address - Country:US
Practice Address - Phone:773-841-3112
Practice Address - Fax:773-841-3112
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional