Provider Demographics
NPI:1033643085
Name:DAVIS, BRIANIA NICOLE (MFTA TCADC)
Entity Type:Individual
Prefix:MRS
First Name:BRIANIA
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MFTA TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MARBROOK LN
Mailing Address - Street 2:
Mailing Address - City:FINCHVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40022-6716
Mailing Address - Country:US
Mailing Address - Phone:812-431-5269
Mailing Address - Fax:
Practice Address - Street 1:126 MARBROOK LN
Practice Address - Street 2:
Practice Address - City:FINCHVILLE
Practice Address - State:KY
Practice Address - Zip Code:40022-6716
Practice Address - Country:US
Practice Address - Phone:812-431-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171340101YM0800X
KY267701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health