Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist |
NPI | 1316262611 |
---|---|
Provider Name | Barry Dwayne Davis |
First Address | Kernersville, NC 27284-9753 |
Second Address | Seattle, WA 98108-1532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2010 |
Last Update Date | 30/03/2010 |