Individual
STACEY J DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
790 ROBERTS DR, DELTA COUNSELING ASSOC, MONTICELLO, AR 71655
(870) 367-2461
(870) 367-1690
Mailing address
113 GATESWAY DR, MONTICELLO, AR 71655
(870) 723-5324
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1380C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5U665
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/13/2006
Last updated
07/08/2007
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