Healthcare Provider Details

I. General information

NPI: 1720596356
Provider Name (Legal Business Name): CLARISSA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N LOCUST AVE
LAWRENCEBURG TN
38464-3757
US

IV. Provider business mailing address

11373 COCOA BEACH DR
RIVERVIEW FL
33569-2951
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-7232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18473
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21504
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3318
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: