Provider Demographics
NPI:1821054370
Name:DAVIS, CONNIE MARIE (MS PSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS PSYCHOLOGIST
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Other - First Name:
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Mailing Address - Street 1:BOX 122 105 LAKEVIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:MT GRETNA
Mailing Address - State:PA
Mailing Address - Zip Code:17064
Mailing Address - Country:US
Mailing Address - Phone:717-964-3850
Mailing Address - Fax:717-964-3850
Practice Address - Street 1:105 LAKEVIEW ROAD
Practice Address - Street 2:
Practice Address - City:MT GRETNA
Practice Address - State:PA
Practice Address - Zip Code:17064
Practice Address - Country:US
Practice Address - Phone:717-964-3850
Practice Address - Fax:717-964-3850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS005757L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical