Healthcare Provider Details

I. General information

NPI: 1447761879
Provider Name (Legal Business Name): ANNA DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA ANDERSON LPC

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4939 LOWER ROSWELL RD STE 201
MARIETTA GA
30068-4338
US

IV. Provider business mailing address

365 PINE FOREST RD
ATLANTA GA
30342-2759
US

V. Phone/Fax

Practice location:
  • Phone: 770-578-1519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC011932
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC006071
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: