Provider Demographics
NPI:1134248115
Name:DAVIS, PAMELA S (LCPC, LPCS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCPC, LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29W445 RAY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2008
Mailing Address - Country:US
Mailing Address - Phone:239-628-0981
Mailing Address - Fax:
Practice Address - Street 1:29W445 RAY AVE
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2008
Practice Address - Country:US
Practice Address - Phone:239-628-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4494101YM0800X
IL180008635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health