Provider Demographics
NPI:1730425364
Name:DAVIS, ORLANDO (LCSW)
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9204 S COMMERCIAL AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2197
Mailing Address - Country:US
Mailing Address - Phone:888-417-0274
Mailing Address - Fax:888-419-3986
Practice Address - Street 1:9204 S COMMERCIAL AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2197
Practice Address - Country:US
Practice Address - Phone:312-489-7559
Practice Address - Fax:888-419-3986
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490156211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical