Provider Demographics
NPI:1245726280
Name:DAVIS, COREY MOLZON (PSYD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:MOLZON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FRONT AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5364
Mailing Address - Country:US
Mailing Address - Phone:908-489-0551
Mailing Address - Fax:
Practice Address - Street 1:1400 FRONT AVE STE 305
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5364
Practice Address - Country:US
Practice Address - Phone:908-489-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06082103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist