Provider Demographics
NPI:1619149382
Name:DAVIS, RACHEL (LCSW, CCS, LAC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW, CCS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5524 S AFTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3542
Mailing Address - Country:US
Mailing Address - Phone:225-252-2212
Mailing Address - Fax:225-751-6302
Practice Address - Street 1:411 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2527
Practice Address - Country:US
Practice Address - Phone:225-252-2212
Practice Address - Fax:225-751-6302
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA84681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1009OtherLAC
LA600551753Medicaid
LA111OtherCERTIFIED CLINICAL SUPERVISOR
LA8468OtherGSW