Provider Demographics
NPI:1679912414
Name:DAVES, GEORGE ANTHONY (MA LPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ANTHONY
Last Name:DAVES
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 STERLING RANCH RD N
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8536
Mailing Address - Country:US
Mailing Address - Phone:318-707-1123
Mailing Address - Fax:
Practice Address - Street 1:8924 JEWELLA AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2100
Practice Address - Country:US
Practice Address - Phone:318-707-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional