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1841796992
JERRY DAVIS-EL
CHICAGO, IL
NPI
1841796992
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: IL 29962)
Enumeration Date
2018-04-05
Last Update Date
2018-04-05
Business Address
MR. JERRY DAVIS-EL CADC
33 E 114TH ST
CHICAGO, IL 60628-4921
Phone number: 773-660-4630
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Mailing Address
MR. JERRY DAVIS-EL CADC
222 S JEFFERSON ST
CHICAGO, IL 60661-5603
Phone number: 312-441-9009
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