Healthcare Provider Details

I. General information

NPI: 1992676159
Provider Name (Legal Business Name): PORTIA DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 W CALLE BILBOA
TUCSON AZ
85742-0094
US

IV. Provider business mailing address

6240 W CALLE BILBOA
TUCSON AZ
85742-0094
US

V. Phone/Fax

Practice location:
  • Phone: 301-980-0316
  • Fax:
Mailing address:
  • Phone: 770-573-5013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015845
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: