Provider Demographics
NPI:1952448177
Name:DAVIES, JEWEL DAWN (LCPC)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:DAWN
Last Name:DAVIES
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 1:744 W GORDON TER
Mailing Address - Street 2:UNIT 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2270
Mailing Address - Country:US
Mailing Address - Phone:773-975-0477
Mailing Address - Fax:708-974-5114
Practice Address - Street 1:10537 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1933
Practice Address - Country:US
Practice Address - Phone:708-974-5114
Practice Address - Fax:708-974-2498
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health