Healthcare Provider Details

I. General information

NPI: 1871323295
Provider Name (Legal Business Name): KIMBERLY LEATRICE DAVIS M.ED, NCC, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 WIGGINS AVE
CLEVELAND MS
38732-3459
US

IV. Provider business mailing address

512 WIGGINS AVE
CLEVELAND MS
38732-3459
US

V. Phone/Fax

Practice location:
  • Phone: 601-874-0532
  • Fax:
Mailing address:
  • Phone: 601-874-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.61492643
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: