Provider Demographics
NPI:1275742926
Name:DAVIS, ELLEN ODESSA (COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:ODESSA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CRANSTON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-2801
Mailing Address - Country:US
Mailing Address - Phone:706-562-9784
Mailing Address - Fax:
Practice Address - Street 1:4411 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5634
Practice Address - Country:US
Practice Address - Phone:706-327-0279
Practice Address - Fax:706-327-5294
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor