Basic Information
| Provider Information | |||||||||
| NPI: | 1104964543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LPC, NCC, CCDP-D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3508 RACHEL DR | ||||||||
| Address2: | P.O. BOX 3129 | ||||||||
| City: | SULPHUR | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706630377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375282624 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4105 KIRKMAN ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706074603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374758022 | ||||||||
| FaxNumber: | 3374758054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 06/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3475 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.