Provider Demographics
NPI:1790224921
Name:DRAUGHN-DAVIS, WILMA
Entity Type:Individual
Prefix:MRS
First Name:WILMA
Middle Name:
Last Name:DRAUGHN-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 YEARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-9473
Mailing Address - Country:US
Mailing Address - Phone:318-617-0997
Mailing Address - Fax:
Practice Address - Street 1:671 HIGHWAY 171
Practice Address - Street 2:SUITE C
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-6100
Practice Address - Country:US
Practice Address - Phone:318-775-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health