Provider Demographics
NPI:1497978050
Name:DAVIS, CAROL PATRICIA (BA)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:PATRICIA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:PATRICIA
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13840
Mailing Address - Street 2:
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-0840
Mailing Address - Country:US
Mailing Address - Phone:719-338-2862
Mailing Address - Fax:
Practice Address - Street 1:10 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5626
Practice Address - Country:US
Practice Address - Phone:719-338-2862
Practice Address - Fax:719-634-0482
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor