Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | APC005072 | GA |
Y | 101YP2500X | Professional Counselor | LPC010549 | GA |
NPI | 1003364100 |
---|---|
Provider Name | Sarah Davison |
First Address | Decatur, GA 30030-1707 |
Second Address | Decatur, GA 30030-1707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2016 |
Last Update Date | 16/10/2018 |