Provider Demographics
NPI:1760931091
Name:DAVIS, COREEN (LPC)
Entity Type:Individual
Prefix:
First Name:COREEN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 YORK RD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2136
Mailing Address - Country:US
Mailing Address - Phone:267-626-2018
Mailing Address - Fax:267-636-5205
Practice Address - Street 1:505 YORK RD
Practice Address - Street 2:UNIT 4
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2136
Practice Address - Country:US
Practice Address - Phone:267-626-2018
Practice Address - Fax:267-636-5205
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional