Individual
RANDI DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCIT
Contact information
Practice address
719 W MAIN ST, WAUTOMA, WI 54982-8503
(920) 787-7472
(920) 787-5458
Mailing address
719 W MAIN ST, WAUTOMA, WI 54982-8503
(920) 787-7472
(920) 787-5458
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2935-226
WI
Other
Enumeration date
05/16/2016
Last updated
05/16/2016
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