Healthcare Provider Details

I. General information

NPI: 1649004508
Provider Name (Legal Business Name): ANDREA DAVIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2024
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS ANDREA MARIE DAVIS
Title or Position: OWNER
Credential: LPC-S, ATR-BC, ATCS
Phone: 682-252-2590