Individual
MINDY DIANE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
309 W 12TH ST, VANCOUVER, WA 98660-2903
(360) 365-1325
Mailing address
PO BOX 605, VANCOUVER, WA 98666-0605
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LW60062992
WA
1041C0700X
Clinical Social Worker
LW60062992
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70915
BCBS PROVIDER NUMBER
MT
Enumeration date
07/14/2006
Last updated
12/18/2018
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