Provider Demographics
NPI:1376182303
Name:DAVIS, LESLIE BAYLIS (EDD, PSCD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BAYLIS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:EDD, PSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 NUBB RAINEY RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-8188
Mailing Address - Country:US
Mailing Address - Phone:912-659-5045
Mailing Address - Fax:
Practice Address - Street 1:70 NUBB RAINEY RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8188
Practice Address - Country:US
Practice Address - Phone:912-659-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL26846245101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral