Provider Demographics
NPI:1104288380
Name:MARLA DAVIS HENRY LCSW
Entity type:Organization
Organization Name:MARLA DAVIS HENRY LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:ILENE
Authorized Official - Last Name:DAVIS HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-471-3273
Mailing Address - Street 1:647 WICKLOW RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4522
Mailing Address - Country:US
Mailing Address - Phone:847-471-3273
Mailing Address - Fax:847-948-8742
Practice Address - Street 1:647 WICKLOW RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4522
Practice Address - Country:US
Practice Address - Phone:847-471-3273
Practice Address - Fax:847-948-8742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490070331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty