Individual
MS. MADRIGO DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
3300 BUCKEYE RD, SUITE 811, ATLANTA, GA 30341-4229
(770) 220-0477
(770) 220-0478
Mailing address
613 CARDINAL WOODS WAY, EASLEY, SC 29642-1537
(678) 480-5826
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC004150
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10066064
AMERIGROUP
GA
01
—
103665
PEACHSTATE HEALTH PLAN
GA
05
—
467617883B
—
GA
01
—
52210317 001
BCBSGA BEHAVIORAL HEALTH
GA
Enumeration date
01/24/2007
Last updated
05/24/2024
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