Davida Dawana Fuller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149027199 Issued in IL

Practice address

2000 N Racine Ave Ste 3300
Chicago, IL 60614-7008

Phone

(773) 413-9523

NPI assigned

May 28, 2024

Last updated

May 28, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, IL

  Medicare reassignment NPD
• Abbie Kelley, LLC

  dba AMK Counseling

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1386048825
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1023858172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 N RACINE AVE STE 3300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606147008",
            "telephone_number": "773-413-9523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N RACINE AVE STE 3300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606147008",
            "telephone_number": "773-413-9523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "DAVIDA",
        "middle_name": "DAWANA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-28",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149027199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fuller Health Group LLC
• Alexis Fuller, LCSW
• Alisha Fuller, LPC
• Anna Fuller, APN
• Brittany Anne Fuller
• Edwana Denise Fuller, RN
• Eric Bradley Fuller, M.D.
• Ethan C Fuller
• Gigi Legeia Fuller, CADC
• Hannah Fuller, LSW

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.