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General NPI Number Information
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NPI Number | 1629743208
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Entity Type | Individual
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Provider Name | ELYSHA DAVIS NCC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2021
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 704 LINCOLN AVE
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City | DELMAR
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State | DE
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Zip | 19940-1344
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Country | US
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Telephone | 302-217-3926
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Fax |
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Provider Business Mailing Address
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Address Line | 704 LINCOLN AVE
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City | DELMAR
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State | DE
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Zip | 19940-1344
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Country | US
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Telephone | 302-258-5388
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC-0011585
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License Number State | DE
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