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General NPI Number Information
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NPI Number | 1043360639
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Entity Type | Individual
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Provider Name | GWENDOLEN HAYDON DAVIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 467 RED BIRD DR
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City | SPRINGTOWN
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State | TX
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Zip | 76082-2942
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Country | US
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Telephone | 904-716-5619
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Fax | 904-640-7776
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Provider Business Mailing Address
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Address Line | 467 RED BIRD DR
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City | SPRINGTOWN
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State | TX
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Zip | 76082-2942
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Country | US
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Telephone | 904-716-5619
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Fax | 904-640-7776
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW7677
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C003093
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 115462
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License Number State | TX
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