Provider Demographics
NPI:1508933623
Name:DAVIS, ANGEL HUNT (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:HUNT
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BARBER CREEK DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5981
Mailing Address - Country:US
Mailing Address - Phone:706-543-7012
Mailing Address - Fax:706-583-8877
Practice Address - Street 1:1020 BARBER CREEK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5981
Practice Address - Country:US
Practice Address - Phone:706-543-7012
Practice Address - Fax:706-583-8877
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA#80BBDQPMedicare ID - Type Unspecified