Provider Demographics
NPI:1558851865
Name:DAVIS, RAYELLE TIANNE (LGPC)
Entity Type:Individual
Prefix:
First Name:RAYELLE
Middle Name:TIANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:ELLERSLIE
Mailing Address - State:MD
Mailing Address - Zip Code:21529-0394
Mailing Address - Country:US
Mailing Address - Phone:240-727-1700
Mailing Address - Fax:
Practice Address - Street 1:118 VALLEY ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2141
Practice Address - Country:US
Practice Address - Phone:301-722-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP7939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional