Provider Demographics
NPI:1932429933
Name:DAVIS, STEPHEN M (LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 HICKORY ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8350
Mailing Address - Country:US
Mailing Address - Phone:706-279-0405
Mailing Address - Fax:706-279-4190
Practice Address - Street 1:1622 HICKORY ST
Practice Address - Street 2:SUITE 304
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8350
Practice Address - Country:US
Practice Address - Phone:706-279-0405
Practice Address - Fax:706-279-4190
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000280101YP2500X
GAMFT000469106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist