Provider Demographics
NPI:1891019154
Name:DAVIS, THOMAS L (LCSW - BACS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW - BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8778 HIGHWAY 1200
Mailing Address - Street 2:
Mailing Address - City:BOYCE
Mailing Address - State:LA
Mailing Address - Zip Code:71409-8776
Mailing Address - Country:US
Mailing Address - Phone:318-201-7816
Mailing Address - Fax:
Practice Address - Street 1:201 JOHNSTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8388
Practice Address - Country:US
Practice Address - Phone:318-201-7816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical