Basic Information
| Provider Information | |||||||||
| NPI: | 1588700942 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | EVE | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1932 HICKORY TRL NE | ||||||||
| Address2: | |||||||||
| City: | ARAB | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350165340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569316559 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1909 COMMERCE AVE | ||||||||
| Address2: | |||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350556151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567344688 | ||||||||
| FaxNumber: | 2567365638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 51533495 | 01 | AL | BCBS | OTHER |