Doctor Name: | MRS. JOANNA R. DAVIS |
NPI Number: | 1063712297 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH 10454 |
Business Practice Address: | 68 Beal Pkwy Sw Fort Walton Beach, FL - 325485331 |
Business Phone Number: | 8502437035 |
Business Fax Number: | 8502438529 |
Mailing Address: | Po Box 879, FORT WALTON BEACH |
State: | FL |
Postal Code: | 325490879 |
Phone Number: | 8502437035 |
Fax Number: | 8502438529 |
NPI Enumeration Date: | 10/21/2010 |
NPI Last Update Date: | 10/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 10454 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |