Provider Demographics
NPI:1598005514
Name:DAVIS MENTAL HEALTH COUNSELING SERVICES
Entity Type:Organization
Organization Name:DAVIS MENTAL HEALTH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC
Authorized Official - Phone:407-416-5454
Mailing Address - Street 1:75 FOX RIDGE CT STE C
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2701
Mailing Address - Country:US
Mailing Address - Phone:407-416-5454
Mailing Address - Fax:321-275-4826
Practice Address - Street 1:75 FOX RIDGE CT STE C
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2701
Practice Address - Country:US
Practice Address - Phone:407-416-5454
Practice Address - Fax:321-275-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty