Provider Demographics
NPI:1689561946
Name:DAVIS, JAMIE SUZANNE (LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:SUZANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:SUZANNE
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 EARL FRYE BLVD # ANA
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5507
Mailing Address - Country:US
Mailing Address - Phone:662-256-9331
Mailing Address - Fax:
Practice Address - Street 1:900 EARL FRYE BLVD # ANA
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5507
Practice Address - Country:US
Practice Address - Phone:662-256-9331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3314101Y00000X
ALLPC05596101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor