Basic Information
| Provider Information | |||||||||
| NPI: | 1417247016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6210 DOLLARWAY RD | ||||||||
| Address2: | STE 4 | ||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716023733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702473588 | ||||||||
| FaxNumber: | 8702472072 | ||||||||
| Practice Location | |||||||||
| Address1: | 6210 DOLLARWAY RD | ||||||||
| Address2: | STE 4 | ||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716023733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702473588 | ||||||||
| FaxNumber: | 8702472072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2011 | ||||||||
| LastUpdateDate: | 04/15/2011 | ||||||||
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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 | 104100000X | 064-C | AR | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.