Provider Demographics
NPI:1619029246
Name:DAVIS, CAROLYN (LPCC, LSW)
Entity Type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPCC, LSW
Other - Prefix:MRS
Other - First Name:JEANNINE
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HR ASSISTANT
Mailing Address - Street 1:3048 HACKBERRY ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1410
Mailing Address - Country:US
Mailing Address - Phone:513-961-3283
Mailing Address - Fax:
Practice Address - Street 1:4050 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 404
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2089
Practice Address - Country:US
Practice Address - Phone:513-381-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE - 0001341,101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health