Provider Demographics
NPI:1295035384
Name:DAVIS, ERIN DUBOSE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:DUBOSE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SABAL PALM DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2592
Mailing Address - Country:US
Mailing Address - Phone:407-864-4522
Mailing Address - Fax:407-869-1006
Practice Address - Street 1:165 SABAL PALM DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2592
Practice Address - Country:US
Practice Address - Phone:407-864-4522
Practice Address - Fax:407-869-1006
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist