Provider Demographics
NPI:1154762391
Name:DAVIS, LINDA JANE (LCSW, LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 BREWTON LOVETT RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31027-3299
Mailing Address - Country:US
Mailing Address - Phone:478-278-1898
Mailing Address - Fax:
Practice Address - Street 1:1107 BREWTON LOVETT RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027-3299
Practice Address - Country:US
Practice Address - Phone:478-278-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007025101YM0800X
GACSW0059971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health