Provider Demographics
NPI:1851619308
Name:DAVIS, SANDRA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:13023 TESSON FERRY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3480
Mailing Address - Country:US
Mailing Address - Phone:362-320-3406
Mailing Address - Fax:636-600-8714
Practice Address - Street 1:13023 TESSON FERRY RD STE 107
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3480
Practice Address - Country:US
Practice Address - Phone:636-232-0340
Practice Address - Fax:636-600-8714
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007002474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional