Individual
CHRISTOPHER JEROME DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4951 CENTRAL AVE, MONROE, LA 71203-6156
(318) 340-1535
Mailing address
850 KALISTE SALOOM RD STE 117, LAFAYETTE, LA 70508-4230
(337) 234-7109
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295285898
—
LA
Enumeration date
10/06/2016
Last updated
07/06/2018
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