Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 40444 | TX |
N | 1041C0700X | Clinical Social Worker |
NPI | 1003034695 |
---|---|
Provider Name | Mrs. Deborah Sue Davis |
First Address | Royse City, TX 75189-1283 |
Second Address | Royse City, TX 75189-7836 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2007 |
Last Update Date | 17/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1808388 | (02) | TX |
1808388-02 | (02) | TX |