Provider Demographics
NPI:1649435124
Name:DAVIS, DIANA KENDALL (MHC-EXTERN)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:KENDALL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MHC-EXTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BENNER RD
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1543
Mailing Address - Country:US
Mailing Address - Phone:845-758-0241
Mailing Address - Fax:845-758-5746
Practice Address - Street 1:30 BENNER RD
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1543
Practice Address - Country:US
Practice Address - Phone:845-758-0241
Practice Address - Fax:845-758-5746
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health