Provider Demographics
NPI:1336318260
Name:DAVIS, GLENDA JOYCE (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:JOYCE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3381
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-3381
Mailing Address - Country:US
Mailing Address - Phone:479-738-7059
Mailing Address - Fax:479-935-4573
Practice Address - Street 1:4257 N GABEL DR STE 2B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5038
Practice Address - Country:US
Practice Address - Phone:479-738-7059
Practice Address - Fax:799-354-5734
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1003023101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional