Healthcare Provider Details

I. General information

NPI: 1326793654
Provider Name (Legal Business Name): DAVIS ABRAHAM LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 ENTERPRISE DR STE A
OXFORD MS
38655-2762
US

IV. Provider business mailing address

304 ENTERPRISE DR STE A
OXFORD MS
38655-2762
US

V. Phone/Fax

Practice location:
  • Phone: 662-638-3026
  • Fax:
Mailing address:
  • Phone: 662-638-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2700
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2700
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: