Individual
TIA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS
Contact information
Practice address
622 RIVERSIDE DR, MONROE, LA 71201-6211
(318) 398-0945
Mailing address
622 RIVERSIDE DR, MONROE, LA 71201-6211
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PLC10603
LA
Other
Enumeration date
05/19/2023
Last updated
04/08/2025
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