Provider Demographics
NPI:1780440438
Name:CARR-DAVIS, GOLDIE
Entity type:Individual
Prefix:
First Name:GOLDIE
Middle Name:
Last Name:CARR-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N MCLEAN BLVD STE 512
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5964
Mailing Address - Country:US
Mailing Address - Phone:316-371-8389
Mailing Address - Fax:
Practice Address - Street 1:423 N MCLEAN BLVD STE 512
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5964
Practice Address - Country:US
Practice Address - Phone:316-371-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health