Healthcare Provider Details

I. General information

NPI: 1366841421
Provider Name (Legal Business Name): JOELY DAVIDSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 OAK RIDGE WAY E STE 6
WEST FARGO ND
58078-8417
US

IV. Provider business mailing address

530 OAK RIDGE WAY E STE 6
WEST FARGO ND
58078-8417
US

V. Phone/Fax

Practice location:
  • Phone: 701-380-3171
  • Fax: 701-248-4783
Mailing address:
  • Phone: 701-380-3171
  • Fax: 701-248-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: