Provider Demographics
NPI:1477645695
Name:DAVIS, JONATHAN C (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 ALFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3127
Mailing Address - Country:US
Mailing Address - Phone:205-824-8320
Mailing Address - Fax:
Practice Address - Street 1:1313 ALFORD AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3127
Practice Address - Country:US
Practice Address - Phone:205-824-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLMFT 276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist