Provider Demographics
NPI:1407811714
Name:DAVIS, LINDA S (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
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 12254
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29504-2254
Mailing Address - Country:US
Mailing Address - Phone:843-615-0840
Mailing Address - Fax:843-629-0055
Practice Address - Street 1:417 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2543
Practice Address - Country:US
Practice Address - Phone:843-615-0840
Practice Address - Fax:843-629-0055
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional