Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003374158 |
---|---|
Provider Name | Shawna Davis |
First Address | Jacksonville, AL 36265-5162 |
Second Address | Jacksonville, AL 36265-4306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2019 |
Last Update Date | 07/03/2019 |