Provider Demographics
NPI:1700543808
Name:DAVIS, TANYA LEIGH (LCSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 APPLEDORE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6846
Mailing Address - Country:US
Mailing Address - Phone:904-662-1288
Mailing Address - Fax:
Practice Address - Street 1:5404 APPLEDORE LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-6846
Practice Address - Country:US
Practice Address - Phone:904-662-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW186041041C0700X
GACSW0077791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical