Provider Demographics
NPI:1972290641
Name:DAVIS, KATHERINE MICHELLE (RSW, BA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RSW, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 GLENMAR AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4932
Mailing Address - Country:US
Mailing Address - Phone:318-327-5344
Mailing Address - Fax:318-327-5348
Practice Address - Street 1:1808 GLENMAR AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4932
Practice Address - Country:US
Practice Address - Phone:318-327-5344
Practice Address - Fax:318-327-5348
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104100000X
LA8498104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker