Provider Demographics
NPI:1477008845
Name:DAVISON, MELISSA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 SYLVIA DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0878
Mailing Address - Country:US
Mailing Address - Phone:903-826-7931
Mailing Address - Fax:
Practice Address - Street 1:3802 SYLVIA DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0878
Practice Address - Country:US
Practice Address - Phone:903-826-7931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional