Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 646368 | GA |
Y | 101YS0200X | School Counselor | 646368 | GA |
NPI | 1235556283 |
---|---|
Provider Name | Mrs. Cassandra Lewis Davis |
First Address | Decatur, GA 30034-7123 |
Second Address | Decatur, GA 30034-7123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 27/03/2014 |