Doctor Name: | JESSICA DAVIDSON |
NPI Number: | 1053766980 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC, ATR |
License Number: | 180008597 |
Business Practice Address: | 2480 Eagle Forest Dr Saint Charles, MO - 633038316 |
Business Phone Number: | 3142553405 |
Business Fax Number: | |
Mailing Address: | 2480 Eagle Forest Dr, SAINT CHARLES |
State: | MO |
Postal Code: | 633038316 |
Phone Number: | 3142553405 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2016 |
NPI Last Update Date: | 04/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180008597 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |