Provider Demographics
NPI:1891206462
Name:DAVIS, NICOSIA (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOSIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HUGHES RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2434
Mailing Address - Country:US
Mailing Address - Phone:256-325-1556
Mailing Address - Fax:
Practice Address - Street 1:20 HUGHES RD STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2434
Practice Address - Country:US
Practice Address - Phone:256-325-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4288G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker