Provider Demographics
NPI:1790247732
Name:DAVIS, CASSIE (MS,NCC,LPC)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS,NCC,LPC
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:EMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,NCC,LPC
Mailing Address - Street 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:
Practice Address - Street 1:1070 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:PA
Practice Address - Zip Code:15333-2114
Practice Address - Country:US
Practice Address - Phone:724-632-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health