MEDICARE: MISS CAROLYN DAVIS LPCC, LSW

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	101YM0800X	Mental Health Counselor	E - 0001341,	OH

General Provider Information

NPI Number	:	1619029246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAROLYN DAVIS LPCC, LSW

Provider Business Mailing Address
First Line	:	3048 HACKBERRY ST
Second Line	:	APT. 2
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1410
Country	:	US
Telephone Number	:	513-961-3283
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 EXECUTIVE PARK DR
Second Line	:	SUITE 404
City	:	CINCINNATI
State	:	OH
Zip	:	45241-2089
Country	:	US
Telephone Number	:	513-381-6300
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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