Individual
LISA M DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDC12318
Contact information
Practice address
26229 N CRANES MILL RD, CANYON LAKE, TX 78133-1957
(830) 935-2800
Mailing address
26229 N CRANES MILL RD, CANYON LAKE, TX 78133-1957
(830) 935-2800
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
12318
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37690446
DRIVERS LICENSE
TX
Enumeration date
04/06/2021
Last updated
04/06/2021
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