Healthcare Provider Details

I. General information

NPI: 1871753947
Provider Name (Legal Business Name): JANE MOULDER DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TECHNOLOGY CT SE STE J
SMYRNA GA
30082-5237
US

IV. Provider business mailing address

400 TECHNOLOGY CT SE STE J
SMYRNA GA
30082-5237
US

V. Phone/Fax

Practice location:
  • Phone: 770-431-2354
  • Fax: 770-436-7143
Mailing address:
  • Phone: 770-431-2354
  • Fax: 770-436-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC001735
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: