Provider Demographics
NPI:1205850344
Name:DAVIS, MARIE A (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S VOLUSIA AVE
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7625
Mailing Address - Country:US
Mailing Address - Phone:407-416-5454
Mailing Address - Fax:386-775-7268
Practice Address - Street 1:2425 S VOLUSIA AVE
Practice Address - Street 2:SUITE B-4
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7625
Practice Address - Country:US
Practice Address - Phone:407-416-5454
Practice Address - Fax:386-775-7268
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health