Provider Demographics
NPI:1003360256
Name:DAVIS, PAULA (EDS, LPC, NCC, NCSC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:EDS, LPC, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-9045
Mailing Address - Country:US
Mailing Address - Phone:601-410-7771
Mailing Address - Fax:601-735-0823
Practice Address - Street 1:72 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-9045
Practice Address - Country:US
Practice Address - Phone:601-410-7771
Practice Address - Fax:601-735-4195
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86963101YP2500X
MS2116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional