Provider Demographics
NPI:1104501709
Name:DAVIS, PATRIE (LCSW)
Entity type:Individual
Prefix:
First Name:PATRIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6197 PUMPING STATION RD SE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:IN
Mailing Address - Zip Code:47117-9311
Mailing Address - Country:US
Mailing Address - Phone:812-267-1201
Mailing Address - Fax:
Practice Address - Street 1:6197 PUMPING STATION RD SE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:IN
Practice Address - Zip Code:47117-9311
Practice Address - Country:US
Practice Address - Phone:317-997-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010397A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical