Individual
TINA RICHELLE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 VETERANS AVE, BILOXI, MS 39531-2410
(228) 523-5000
Mailing address
731 DORA STREET, WIGGINS, MS 39577
(601) 310-6646
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M9403
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
05/22/2019
Last updated
05/22/2019
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