Basic Information
| Provider Information | |||||||||
| NPI: | 1295291532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIES | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 AMARILLO DR | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703607285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858567101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 CIVIC CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703605937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853332020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2019 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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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 | 1041C0700X | 4227 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.