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NPI Code Detail

MEDICARE: MR. DYLAN ROSS DAVIS LPC

MEDICARE: MR. DYLAN ROSS 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
1101YP2500XProfessional Counselor6692SC

General Provider Information

NPI Number : 1649783978
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DYLAN ROSS DAVIS LPC
Provider Business Mailing Address
First Line : 2215 OLD CHEROKEE RD
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-9726
Country : US
Telephone Number : 864-985-2585
Fax Number :
Provider Business Practice Location Address
First Line : 714 S LAKE DR STE 120
Second Line :
City : LEXINGTON
State : SC
Zip : 29072-3473
Country : US
Telephone Number : 803-520-8295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2017
Last Update Date : 11/08/2017

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Directions to “ MR. DYLAN ROSS DAVIS LPC” Practice Location

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