Healthcare Provider Details

I. General information

NPI: 1518883792
Provider Name (Legal Business Name): CORISA DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 LAKE PLAZA DR # 22
COLORADO SPRINGS CO
80906-3581
US

IV. Provider business mailing address

1849 FLINTSHIRE ST
COLORADO SPRINGS CO
80910-3229
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932719
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6636C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: