Provider Demographics
NPI:1104964543
Name:DAVIS, CAROLYN ANN (LPC, NCC, CCDP-D)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, NCC, CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 RACHEL DR
Mailing Address - Street 2:P.O. BOX 3129
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-0377
Mailing Address - Country:US
Mailing Address - Phone:337-528-2624
Mailing Address - Fax:
Practice Address - Street 1:4105 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4603
Practice Address - Country:US
Practice Address - Phone:337-475-8022
Practice Address - Fax:337-475-8054
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional