Provider Demographics
NPI:1972537504
Name:DAVIS, OGENE LEWIS (LPC MDIV)
Entity Type:Individual
Prefix:MR
First Name:OGENE
Middle Name:LEWIS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 WILKINSON DR. SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-0073
Mailing Address - Country:US
Mailing Address - Phone:404-373-9885
Mailing Address - Fax:404-297-2600
Practice Address - Street 1:778 RAYS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3107
Practice Address - Country:US
Practice Address - Phone:404-292-3600
Practice Address - Fax:404-297-2600
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional