Provider Demographics
NPI:1851009021
Name:DAVIDSON, EUGENIE JOSEPHINE (LAC)
Entity Type:Individual
Prefix:MS
First Name:EUGENIE
Middle Name:JOSEPHINE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 NW C ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5224
Mailing Address - Country:US
Mailing Address - Phone:479-644-1367
Mailing Address - Fax:
Practice Address - Street 1:2103 S 54TH ST STE 2
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8126
Practice Address - Country:US
Practice Address - Phone:479-372-7446
Practice Address - Fax:877-373-5118
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2210020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health