Provider Demographics
NPI:1972845873
Name:DAVIS, MARY JOE (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 JESSIE ST
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-5408
Mailing Address - Country:US
Mailing Address - Phone:724-758-5617
Mailing Address - Fax:
Practice Address - Street 1:130 JESSIE ST
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-5408
Practice Address - Country:US
Practice Address - Phone:724-758-5617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health