Provider Demographics
NPI:1073049581
Name:DAVIS, KINDALL (LPC)
Entity Type:Individual
Prefix:
First Name:KINDALL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 CRAIG ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126-9744
Mailing Address - Country:US
Mailing Address - Phone:412-259-3394
Mailing Address - Fax:412-533-2696
Practice Address - Street 1:2400 ANSYS DR.
Practice Address - Street 2:STE 102
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:412-737-0990
Practice Address - Fax:412-533-2696
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC009970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health