Healthcare Provider Details

I. General information

NPI: 1750311379
Provider Name (Legal Business Name): ANDREA MARIE DAVIS LPC-S, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 N COLLINS BLVD STE 411
RICHARDSON TX
75080-2665
US

IV. Provider business mailing address

8915 GROVELAND DR
DALLAS TX
75218-4217
US

V. Phone/Fax

Practice location:
  • Phone: 972-544-6633
  • Fax: 214-237-1269
Mailing address:
  • Phone: 682-252-2590
  • Fax: 214-237-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20227
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20227
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: