Provider Demographics
NPI:1023626843
Name:DAVIS, CHRISTINA MACHELLE (P-LPC, MS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MACHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:P-LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2804
Mailing Address - Country:US
Mailing Address - Phone:228-243-3421
Mailing Address - Fax:
Practice Address - Street 1:2352 E PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-3805
Practice Address - Country:US
Practice Address - Phone:228-284-2337
Practice Address - Fax:228-284-2337
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0584101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty