Provider Demographics
NPI:1760853527
Name:DAVIS, CARL
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 GEN DEGAULLE DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-6941
Mailing Address - Country:US
Mailing Address - Phone:504-309-6798
Mailing Address - Fax:504-407-2115
Practice Address - Street 1:4480 GEN DEGAULLE DR
Practice Address - Street 2:SUITE 117
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-6941
Practice Address - Country:US
Practice Address - Phone:504-309-6798
Practice Address - Fax:504-407-2115
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health