Provider Demographics
NPI:1568085876
Name:LAURA IRENE DAVIS
Entity Type:Organization
Organization Name:LAURA IRENE DAVIS
Other - Org Name:CONQUERING WALLS COUNSELING AGENCY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:I
Authorized Official - Last Name:DAVIS-PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-SUPV
Authorized Official - Phone:614-586-3830
Mailing Address - Street 1:1725 KENWICK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3247
Mailing Address - Country:US
Mailing Address - Phone:614-586-3830
Mailing Address - Fax:614-869-2397
Practice Address - Street 1:2020 BRICE RD STE 110
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3448
Practice Address - Country:US
Practice Address - Phone:614-706-5099
Practice Address - Fax:614-869-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.1700380OtherLISW-SUPV