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General NPI Number Information
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NPI Number | 1972054476
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Entity Type | Organization
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Legal Business Name | LISA M. DAVIS, LLC
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 351 6TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-8820
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Country | US
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Telephone | 941-737-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 351 6TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-8820
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Country | US
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Telephone | 941-737-8897
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. LISA M DAVIS
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Credential | PH. D., LMHC
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Telephone | 941-737-8897
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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 | MH4468
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License Number State | FL
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