Provider Demographics
NPI:1326118191
Name:DAVIS, ELAINE CAROL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:CAROL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 JOHN DAVID DR APT A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-2643
Mailing Address - Country:US
Mailing Address - Phone:903-780-3225
Mailing Address - Fax:
Practice Address - Street 1:4803 JOHN DAVID DR APT A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-2643
Practice Address - Country:US
Practice Address - Phone:903-780-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX382201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical