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General NPI Number Information
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NPI Number | 1740621614
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Entity Type | Individual
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Provider Name | LISA G DAVIES PC
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 102 E GAMBIER ST
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City | MOUNT VERNON
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State | OH
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Zip | 43050-3510
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Country | US
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Telephone | 740-392-5416
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Fax |
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Provider Business Mailing Address
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Address Line | 8038 MARION RD
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City | NEWARK
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State | OH
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Zip | 43055-9527
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Country | US
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Telephone | 740-745-2091
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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 | C.1100503
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License Number State | OH
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