Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2116 | MS |
NPI | 1003360256 |
---|---|
Provider Name | Paula Davis |
First Address | Waynesboro, MS 39367-9045 |
Second Address | Waynesboro, MS 39367-9045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2016 |
Last Update Date | 04/08/2016 |