Provider Demographics
NPI:1356675375
Name:MARCIA L DAVIS, PA
Entity Type:Organization
Organization Name:MARCIA L DAVIS, PA
Other - Org Name:TWELVE STONES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:407-353-3218
Mailing Address - Street 1:51 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9617
Mailing Address - Country:US
Mailing Address - Phone:407-353-3218
Mailing Address - Fax:
Practice Address - Street 1:51 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9617
Practice Address - Country:US
Practice Address - Phone:407-353-3218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6337101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty