Individual
LISA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,MS,LPC
Contact information
Practice address
8040 LOUIS DR, LOCUST GROVE, GA 30248-7111
(708) 955-8451
Mailing address
8040 LOUIS DR, LOCUST GROVE, GA 30248-7111
(708) 955-8451
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
11/19/2020
Last updated
05/31/2023
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