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General NPI Number Information
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NPI Number | 1316043649
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Entity Type | Individual
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Provider Name | TIMOTHY WANYE DAVIS CRD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5201 RAYMOND ST
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City | ORLANDO
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State | FL
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Zip | 32803-8208
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Country | US
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Telephone | 321-397-6092
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Fax |
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Provider Business Mailing Address
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Address Line | 9228 CARDINAL MEADOW TRAIL
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City | ORLANDO
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State | FL
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Zip | 32827
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Country | US
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Telephone | 727-742-5121
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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