Individual
INDIA KALA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
5113 S HARPER AVE # 2042, CHICAGO, IL 60615-4119
(312) 927-6642
Mailing address
4747 S KING DR APT 803, CHICAGO, IL 60615-1351
(312) 927-6642
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.012922
IL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245512219
BCBSIL PPO
IL
Enumeration date
09/15/2011
Last updated
10/02/2020
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