Provider Demographics
NPI:1528544293
Name:DAVIS, ERIN MARIE (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 S 50 E
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-8011
Mailing Address - Country:US
Mailing Address - Phone:260-563-1158
Mailing Address - Fax:260-563-0318
Practice Address - Street 1:5233 S 50 E
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-8011
Practice Address - Country:US
Practice Address - Phone:260-563-1158
Practice Address - Fax:260-563-0318
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042897A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical