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General NPI Number Information
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NPI Number | 1568085876
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Entity Type | Organization
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Legal Business Name | LAURA IRENE DAVIS
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 6810 E MAIN ST STE 201
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-2217
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Country | US
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Telephone | 614-357-0686
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Fax | 614-725-0402
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Provider Business Mailing Address
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Address Line | 6810 E MAIN ST STE 201 MAILBOX #4
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-2217
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Country | US
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Telephone | 614-357-0686
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Fax | 614-725-0402
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | LAURA I DAVIS-PERRY
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Credential | LISW-SUPV
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Telephone | 614-586-3830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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