Provider Demographics
NPI:1154680346
Name:WAYNE E. DAVIDSON, LMHC
Entity Type:Organization
Organization Name:WAYNE E. DAVIDSON, LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-979-0535
Mailing Address - Street 1:14437 UNIVERSITY COVE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1546
Mailing Address - Country:US
Mailing Address - Phone:813-979-0535
Mailing Address - Fax:813-975-9769
Practice Address - Street 1:14437 UNIVERSITY COVE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3741
Practice Address - Country:US
Practice Address - Phone:813-979-0535
Practice Address - Fax:813-975-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4879251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001296600Medicaid