Provider Demographics
NPI:1194288936
Name:DAVIS, SONDRA (LMSW)
Entity type:Individual
Prefix:
First Name:SONDRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CRAIN HWY S STE 503
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6443
Mailing Address - Country:US
Mailing Address - Phone:443-354-1200
Mailing Address - Fax:410-553-0016
Practice Address - Street 1:1829 REISTERSTOWN RD STE 460
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-7107
Practice Address - Country:US
Practice Address - Phone:443-354-1200
Practice Address - Fax:410-553-0019
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22377101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health