Provider Demographics
NPI:1851934210
Name:DAVIS, ROSALYN DONZETTA (CADCII, MAT)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:DONZETTA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CADCII, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MALCOLM CT
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-5849
Mailing Address - Country:US
Mailing Address - Phone:770-601-5719
Mailing Address - Fax:
Practice Address - Street 1:105 COLLEGE CT
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-4402
Practice Address - Country:US
Practice Address - Phone:478-293-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACADCII1323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)