Basic Information
| Provider Information | |||||||||
| NPI: | 1649594391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MDIV, MS, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 179 PIERCE AVE | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312042821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787421464 | ||||||||
| FaxNumber: | 4787421883 | ||||||||
| Practice Location | |||||||||
| Address1: | 179 PIERCE AVE | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312042821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787421464 | ||||||||
| FaxNumber: | 4787421883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 03/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5891 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.