Provider Demographics
NPI:1235839945
Name:DAVIDSON, ELISE (LPCC)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 DOUGLAS DR N APT 111
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4337
Mailing Address - Country:US
Mailing Address - Phone:612-405-9307
Mailing Address - Fax:
Practice Address - Street 1:1350 DOUGLAS DR N APT 111
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4337
Practice Address - Country:US
Practice Address - Phone:612-405-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01642101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor