Provider Demographics
NPI:1093525180
Name:DAVIDSON, INA-DALE NMN (MSW)
Entity type:Individual
Prefix:
First Name:INA-DALE
Middle Name:NMN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BULLDOG LN
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-6081
Mailing Address - Country:US
Mailing Address - Phone:606-548-3696
Mailing Address - Fax:
Practice Address - Street 1:12 GARDEN LN LOT 2
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-6569
Practice Address - Country:US
Practice Address - Phone:606-568-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical