Provider Demographics
NPI:1972876894
Name:DAVIS, ANGELIQUE D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:D
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:320 E MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3836
Mailing Address - Country:US
Mailing Address - Phone:615-473-2815
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:320 E MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3836
Practice Address - Country:US
Practice Address - Phone:615-473-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical