Provider Demographics
NPI:1134574270
Name:DAVIS, SHONDRA (LMSW)
Entity type:Individual
Prefix:
First Name:SHONDRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SUMMER BREEZE DR APT 1208
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6380
Mailing Address - Country:US
Mailing Address - Phone:601-214-7688
Mailing Address - Fax:
Practice Address - Street 1:7850 ANSELMO LN STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1101
Practice Address - Country:US
Practice Address - Phone:225-761-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA154771041C0700X
MS58766225800000X
MSM8637104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist