Healthcare Provider Details

I. General information

NPI: 1689504029
Provider Name (Legal Business Name): MIA ALEXUS DAVIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 HIGHWAY 29 S
TROY AL
36079-8808
US

IV. Provider business mailing address

608 HIGHWAY 29 S
TROY AL
36079-8808
US

V. Phone/Fax

Practice location:
  • Phone: 334-770-0421
  • Fax: 334-770-0422
Mailing address:
  • Phone: 334-770-0421
  • Fax: 334-770-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7028G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: