Provider Demographics
NPI:1821714890
Name:DAVIS, OLIVIA LEEANNA (MS)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:LEEANNA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:OLIVIA
Other - Middle Name:LEEANNA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:1 SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1853
Mailing Address - Country:US
Mailing Address - Phone:877-834-9302
Mailing Address - Fax:
Practice Address - Street 1:1 SUSSEX AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1853
Practice Address - Country:US
Practice Address - Phone:877-834-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE106S00000106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician