Provider Demographics
NPI:1922147370
Name:DAVIS, SUE JEAN (LCDC,LBSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:JEAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCDC,LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 EMMETT F LOWRY EXPY
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2628
Mailing Address - Country:US
Mailing Address - Phone:409-736-2373
Mailing Address - Fax:
Practice Address - Street 1:123 25TH ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-1494
Practice Address - Country:US
Practice Address - Phone:409-763-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2931101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8533BHOtherBLUE CROSS BLUE SHIELD