Provider Demographics
NPI:1164857132
Name:DAVIS, MICKIE WILLIAMS
Entity Type:Individual
Prefix:MRS
First Name:MICKIE
Middle Name:WILLIAMS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:HEMINGWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29554-5314
Mailing Address - Country:US
Mailing Address - Phone:843-558-6113
Mailing Address - Fax:
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HEMINGWAY
Practice Address - State:SC
Practice Address - Zip Code:29554-6442
Practice Address - Country:US
Practice Address - Phone:843-558-2721
Practice Address - Fax:843-558-0792
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor