Individual
JUANITA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
2910 MONTICELLO PL, DECATUR, GA 30030-4613
(678) 680-9558
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CSW003751
GA
101YM0800X
Mental Health Counselor
Primary
CSW003751
GA
Other
Enumeration date
01/02/2017
Last updated
01/02/2017
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