Basic Information
| Provider Information | |||||||||
| NPI: | 1720562556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | NEASHION | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 STEAM PLANT ROAD | ||||||||
| Address2: | |||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015970403 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1644 B CARTER STREET. SUITE #2 | ||||||||
| Address2: | |||||||||
| City: | VIDALIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184143065 | ||||||||
| FaxNumber: | 3184143065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.