Provider Demographics
NPI:1346505112
Name:TERRY E DAVIS LCSW LLC
Entity Type:Organization
Organization Name:TERRY E DAVIS LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-731-5505
Mailing Address - Street 1:2701 W OAKLAND PARK BLVD
Mailing Address - Street 2:225C
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1388
Mailing Address - Country:US
Mailing Address - Phone:954-731-5505
Mailing Address - Fax:954-731-5504
Practice Address - Street 1:2701 W OAKLAND PARK BLVD
Practice Address - Street 2:225C
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1388
Practice Address - Country:US
Practice Address - Phone:954-731-5505
Practice Address - Fax:954-731-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW107921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty