Provider Demographics
NPI:1659532687
Name:DAVIS, NATASHA MONIQUE (MS)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:MONIQUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:MONIQUE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:709 DAVIDSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:709 DAVIDSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3607
Practice Address - Country:US
Practice Address - Phone:931-247-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51590559OtherBCBS