Provider Demographics
NPI:1770713349
Name:DAVIS, CAROL SUSAN (MA, MHP, CMHS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:SUSAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, MHP, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4023
Mailing Address - Country:US
Mailing Address - Phone:360-705-2968
Mailing Address - Fax:
Practice Address - Street 1:521 UNION AVE SE
Practice Address - Street 2:SUITE 201
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1487
Practice Address - Country:US
Practice Address - Phone:360-701-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00051644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health