Individual
JANE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
448 LAKESHORE PKWY, ROCK HILL, SC 29730-4264
(803) 329-3177
(803) 329-3319
Mailing address
10048 TEPA PL, TEGA CAY, SC 29708-9330
(803) 287-7649
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
102585
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568476885
—
SC
Enumeration date
01/10/2017
Last updated
01/10/2017
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