Individual
DIANE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2525 MOODY ROAD STE 123, WARNER ROBBINS, GA 31088-6110
(912) 507-3362
Mailing address
1114 GA HIGHWAY 96 STE C1, KATHLEEN, GA 31047-4102
(912) 507-3362
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
APC007072
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APC007072
STATE LICENSE
GA
Enumeration date
03/22/2021
Last updated
02/29/2024
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