Provider Demographics
NPI:1659579696
Name:DAVIS, MILLICENT EVETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MILLICENT
Middle Name:EVETTE
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 1:12700 HILLCREST RD
Mailing Address - Street 2:SUITE 249
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2033
Mailing Address - Country:US
Mailing Address - Phone:972-233-1010
Mailing Address - Fax:972-233-1099
Practice Address - Street 1:235 E 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2807
Practice Address - Country:US
Practice Address - Phone:773-371-3668
Practice Address - Fax:773-371-3698
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490122631041C0700X
TX521381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical