Individual
MRS. GWENDOLEN HAYDON DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
467 RED BIRD DR, SPRINGTOWN, TX 76082-2942
(904) 716-5619
(904) 640-7776
Mailing address
467 RED BIRD DR, SPRINGTOWN, TX 76082-2942
(904) 716-5619
(904) 640-7776
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
115462
TX
1041C0700X
Clinical Social Worker
C003093
NC
1041C0700X
Clinical Social Worker
Primary
SW7677
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061642215
INIDIVDUAL TAX ID
FL
01
—
2502590
CIGNA-EVERNORTH
FL
01
—
277216
MHN
FL
01
—
Z074E
BCBS OUT OF NETWORK PROV
FL
Enumeration date
01/12/2007
Last updated
12/01/2025
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