Provider Demographics
NPI:1073811261
Name:DAVIS, TAWANA M (MED)
Entity Type:Individual
Prefix:
First Name:TAWANA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-1007
Mailing Address - Country:US
Mailing Address - Phone:413-747-9071
Mailing Address - Fax:413-747-9075
Practice Address - Street 1:227 MILL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-1007
Practice Address - Country:US
Practice Address - Phone:413-747-9071
Practice Address - Fax:413-747-9075
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)