Provider Demographics
NPI:1770863573
Name:DAVIS, GREGORY RAWSON (LPC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:RAWSON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 DEERTREE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4576
Mailing Address - Country:US
Mailing Address - Phone:706-589-5568
Mailing Address - Fax:
Practice Address - Street 1:210 DEERTREE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-4576
Practice Address - Country:US
Practice Address - Phone:706-589-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006298101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor