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General NPI Number Information
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NPI Number | 1144311242
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Entity Type | Individual
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Provider Name | SALLY M DAVIS CISW
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 12033 AGENCY RD # 730
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City | PARKER
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State | AZ
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Zip | 85344-7718
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Country | US
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Telephone | 928-669-3256
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Fax | 928-669-3252
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Provider Business Mailing Address
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Address Line | 1075 CATALINA DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-3007
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Country | US
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Telephone | 928-554-2010
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW6801064488
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License Number State | AZ
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