Provider Demographics
NPI:1780395921
Name:DAVIS, STANLEY BERNARD JR (BA)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:BERNARD
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8061 PLEASANT POINT LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4169
Mailing Address - Country:US
Mailing Address - Phone:313-402-6039
Mailing Address - Fax:
Practice Address - Street 1:141 MCDONALD CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6134
Practice Address - Country:US
Practice Address - Phone:843-294-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health