Provider Demographics
NPI:1710136106
Name:DAVIS, SORA Z (LCMHC)
Entity Type:Individual
Prefix:
First Name:SORA
Middle Name:Z
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 CHEMIN GUAY
Mailing Address - Street 2:
Mailing Address - City:AYER'S CLIFF
Mailing Address - State:QC
Mailing Address - Zip Code:J0B 1C0
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6044
Practice Address - Country:US
Practice Address - Phone:603-447-3347
Practice Address - Fax:603-447-8893
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health