Provider Demographics
NPI:1447627088
Name:DAVIS HENRY, MARLA ILENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:ILENE
Last Name:DAVIS HENRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:ILENE
Other - Last Name:DAVISHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:647 WICKLOW RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015
Mailing Address - Country:US
Mailing Address - Phone:847-471-3273
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0070331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical