Provider Demographics
NPI:1043358484
Name:DAVIS, TARA BONICE (BA)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:BONICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 MCFARLAND ST
Mailing Address - Street 2:APT R-32
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3462
Mailing Address - Country:US
Mailing Address - Phone:865-582-6218
Mailing Address - Fax:
Practice Address - Street 1:225 W 1ST NORTH ST
Practice Address - Street 2:SUIT 302
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4614
Practice Address - Country:US
Practice Address - Phone:423-522-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health