Provider Demographics
NPI:1477721835
Name:DAVIS, LACHELE
Entity Type:Individual
Prefix:MRS
First Name:LACHELE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4869 SE 102ND PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-2912
Mailing Address - Country:US
Mailing Address - Phone:352-347-8769
Mailing Address - Fax:352-307-3560
Practice Address - Street 1:4869 SE 102ND PL
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-2912
Practice Address - Country:US
Practice Address - Phone:352-347-8769
Practice Address - Fax:352-307-3560
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services