Provider Demographics
NPI:1063712297
Name:DAVIS, JOANNA R (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32549-0879
Mailing Address - Country:US
Mailing Address - Phone:850-243-7035
Mailing Address - Fax:850-243-8529
Practice Address - Street 1:68 BEAL PKWY SW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5331
Practice Address - Country:US
Practice Address - Phone:850-243-7035
Practice Address - Fax:850-243-8529
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10454101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health