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General NPI Number Information
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NPI Number | 1023328481
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Entity Type | Individual
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Provider Name | MRS. EDWINA ANNETTE DAVIES
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Gender | Female
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 1000 LOUDOUN RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8478
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Country | US
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Telephone | 310-762-2372
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 LOUDOUN RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-8478
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Country | US
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Telephone | 310-762-2372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 101073854
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 00026
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0005
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License Number State | NC
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