Individual
IDA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
570 WEST CHEYENNE AVENUE, NORTH LAS VEGAS, NV 89030
(702) 205-2513
Mailing address
2626 BLUE REEF DRIVE, NORTH LAS VEGAS, NV 89023
(702) 205-2513
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
MI0553
NV
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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