Provider Demographics
NPI:1639451826
Name:DAVIS, CHRISTINE M (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:HALVEY
Other - Middle Name:M
Other - Last Name:CHRISTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 W PRAIRIE DR STE G
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3123
Mailing Address - Country:US
Mailing Address - Phone:224-406-1337
Mailing Address - Fax:
Practice Address - Street 1:920 W PRAIRIE DR STE G
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3123
Practice Address - Country:US
Practice Address - Phone:224-406-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-04-1796103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst