Provider Demographics
NPI:1083027437
Name:DAVIDSON, TIMOTHY (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 NEW LONDON ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3524
Mailing Address - Country:US
Mailing Address - Phone:318-688-9292
Mailing Address - Fax:
Practice Address - Street 1:847 NEW LONDON ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3524
Practice Address - Country:US
Practice Address - Phone:318-688-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical