Organization
CHARLES E. DAVIS, PH.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES E. DAVIS PH.D. (PRESIDENT AND REGISTERED AGENT)
(708) 431-2245
Entity
Organization
Contact information
Practice address
1010 LAKE ST, SUITE 109, OAK PARK, IL 60301-1147
(708) 431-2245
(708) 383-0198
Mailing address
1010 LAKE ST, SUITE 109, OAK PARK, IL 60301-1147
(708) 431-2245
(708) 383-0198
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071003271
IL
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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