MEDICARE: DIANE DAVIS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	APC007072	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APC007072	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1326624149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE DAVIS LPC

Provider Business Mailing Address
First Line	:	1114 GA HIGHWAY 96 STE C1
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-4102
Country	:	US
Telephone Number	:	912-507-3362
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 MOODY ROAD STE 123
Second Line	:
City	:	WARNER ROBBINS
State	:	GA
Zip	:	31088-6110
Country	:	US
Telephone Number	:	912-507-3362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	02/29/2024

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Directions to “ DIANE DAVIS LPC” Practice Location

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