Provider Demographics
NPI:1497325195
Name:DAVIS, ANTONIO TREMON (LMSW)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:TREMON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 OLD EASTOVER RD
Mailing Address - Street 2:
Mailing Address - City:EASTOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29044-8303
Mailing Address - Country:US
Mailing Address - Phone:803-353-8741
Mailing Address - Fax:
Practice Address - Street 1:3041 OLD EASTOVER RD
Practice Address - Street 2:
Practice Address - City:EASTOVER
Practice Address - State:SC
Practice Address - Zip Code:29044-8303
Practice Address - Country:US
Practice Address - Phone:803-353-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC135711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical