Provider Demographics
NPI:1255039905
Name:DAVIS, STEPHANIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BROOKSIDE DR APT A
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-7221
Mailing Address - Country:US
Mailing Address - Phone:484-318-6912
Mailing Address - Fax:
Practice Address - Street 1:3774 RIDGE PIKE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3169
Practice Address - Country:US
Practice Address - Phone:610-489-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPC014601101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor