Individual
MS. LISA M DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAC-AD
Contact information
Practice address
7121 COLUMBIA GATEWAY DRIVE, COLUMBIA, MD 21046
(410) 872-8753
(410) 313-6212
Mailing address
8930 STANFORD BOULEVARD, COLUMBIA, MD 21045
(410) 313-6202
(410) 313-6212
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
AC0735
MD
Other
Enumeration date
11/06/2014
Last updated
11/06/2014
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