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NPI Code Detail

MEDICARE: ANGELA DAVIS LPC

MEDICARE: ANGELA 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
1101YM0800XMental Health CounselorGA
2101YM0800XMental Health CounselorLPC011237GA

General Provider Information

NPI Number : 1992351654
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA DAVIS LPC
Provider Business Mailing Address
First Line : 1710 LATOUR DR NE
Second Line :
City : MARIETTA
State : GA
Zip : 30066-1971
Country : US
Telephone Number : 770-310-5923
Fax Number :
Provider Business Practice Location Address
First Line : 4045 ORCHARD RD SE STE 110
Second Line :
City : SMYRNA
State : GA
Zip : 30080-4904
Country : US
Telephone Number : 770-293-1950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2019
Last Update Date : 10/20/2023

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