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General NPI Number Information
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NPI Number | 1497997316
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Entity Type | Individual
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Provider Name | LATANYA A DAVIS LPC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 120 S PARK SQ NE SUITE 203
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City | MARIETTA
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State | GA
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Zip | 30060-8602
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Country | US
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Telephone | 678-883-2131
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Fax | 770-419-5752
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Provider Business Mailing Address
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Address Line | 120 S PARK SQ NE SUITE 203
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City | MARIETTA
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State | GA
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Zip | 30060-8602
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Country | US
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Telephone | 678-883-2131
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Fax | 770-419-5752
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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 | LPC006570
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License Number State | GA
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