Provider Demographics
NPI:1285368217
Name:DAVIS, TERESA (AS, BA, CADC II)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AS, BA, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 ARNOLD RD NW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-4816
Mailing Address - Country:US
Mailing Address - Phone:678-986-9568
Mailing Address - Fax:
Practice Address - Street 1:68 ARNOLD RD NW
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-4816
Practice Address - Country:US
Practice Address - Phone:678-986-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0649101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty