Provider Demographics
NPI:1437229549
Name:DAVIS, MOLLIE (LPC)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
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 1:324 SFC 365
Mailing Address - Street 2:
Mailing Address - City:COLT
Mailing Address - State:AR
Mailing Address - Zip Code:72326-8003
Mailing Address - Country:US
Mailing Address - Phone:870-270-1388
Mailing Address - Fax:
Practice Address - Street 1:204 MISSISSIPPI ST S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3025
Practice Address - Country:US
Practice Address - Phone:870-208-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0308077101YM0800X
ARP0808062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health