Provider Demographics
NPI:1194888040
Name:DAVIS, CARLA RAE (LMHC)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:RAE
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 1:607 8TH ST SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2314
Mailing Address - Country:US
Mailing Address - Phone:515-967-9150
Mailing Address - Fax:515-957-8031
Practice Address - Street 1:607 8TH ST SW
Practice Address - Street 2:SUITE C
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2314
Practice Address - Country:US
Practice Address - Phone:515-967-9150
Practice Address - Fax:515-957-8031
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health