Provider Demographics
NPI:1912137332
Name:DAVIS-WEBSTER, ANGELIA
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:
Last Name:DAVIS-WEBSTER
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 1:10071 LYNHAM CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5787
Mailing Address - Country:US
Mailing Address - Phone:901-258-2462
Mailing Address - Fax:901-313-0020
Practice Address - Street 1:10071 LYNHAM CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5787
Practice Address - Country:US
Practice Address - Phone:901-258-2462
Practice Address - Fax:901-313-0020
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst