Individual
KIMBERLY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1310 GOODMAN RD E, SOUTHAVEN, MS 38671-9542
(662) 470-5433
(501) 745-2378
Mailing address
1310 GOODMAN RD E, SOUTHAVEN, MS 38671-9542
(662) 470-5433
(501) 745-2378
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2854
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2854
LICENSE
MS
Enumeration date
08/16/2022
Last updated
08/23/2022
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