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General NPI Number Information
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NPI Number | 1669963708
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Entity Type | Individual
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Provider Name | CRYSTAL LEIGH DAVIS MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 43 LEOPARD RD STE 203
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City | PAOLI
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State | PA
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Zip | 19301-1552
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Country | US
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Telephone | 484-880-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 109 CONREYS WAY
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-1676
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Country | US
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Telephone | 484-880-3004
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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 | PC007343
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License Number State | PA
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