Healthcare Provider Details

I. General information

NPI: 1902451123
Provider Name (Legal Business Name): ANNA K DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST BLDG 725
PETERSON AFB CO
80914-1541
US

IV. Provider business mailing address

PSC 2 BOX 8159
APO AE
09012-0082
US

V. Phone/Fax

Practice location:
  • Phone: 719-306-2077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007278
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberMSW007640
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: