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General NPI Number Information
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NPI Number | 1154845782
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Entity Type | Individual
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Provider Name | JESSICA LYNN DAVIS LICSW
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Gender | Female
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 530 BEACON PKWY W STE 401
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3196
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Country | US
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Telephone | 205-986-9130
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 45TH ST W
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City | BIRMINGHAM
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State | AL
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Zip | 35208-1806
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Country | US
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Telephone | 205-335-5252
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4034C
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License Number State | AL
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