Provider Demographics
NPI:1003394503
Name:DAVIS, LAWONDA MANETTE (MA, PLPC)
Entity Type:Individual
Prefix:
First Name:LAWONDA
Middle Name:MANETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 S 5TH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2447
Mailing Address - Country:US
Mailing Address - Phone:636-699-0636
Mailing Address - Fax:
Practice Address - Street 1:1360 S 5TH ST STE 306
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2447
Practice Address - Country:US
Practice Address - Phone:636-699-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020037394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health