Provider Demographics
NPI:1598368789
Name:DAVIS, LISA (MA,MS,LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA,MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7111
Mailing Address - Country:US
Mailing Address - Phone:708-955-8451
Mailing Address - Fax:
Practice Address - Street 1:8040 LOUIS DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-7111
Practice Address - Country:US
Practice Address - Phone:708-955-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health