Healthcare Provider Details

I. General information

NPI: 1669694543
Provider Name (Legal Business Name): THERESA B DAVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 N FIELDER RD
ARLINGTON TX
76012-4635
US

IV. Provider business mailing address

4470 SHARPSBURG DR
GRAND PRAIRIE TX
75052-1636
US

V. Phone/Fax

Practice location:
  • Phone: 214-729-4451
  • Fax: 972-660-4704
Mailing address:
  • Phone: 214-729-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number19457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: