Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 101073854 | CA |
NPI | 1023328481 |
---|---|
Provider Name | Mrs. Edwina Annette Davies |
First Address | Indian Trail, NC 28079-8478 |
Second Address | Indian Trail, NC 28079-8478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2010 |
Last Update Date | 05/01/2011 |