Provider Demographics
NPI:1427320233
Name:DAVIS, DIANA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WHITING WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6481
Mailing Address - Country:US
Mailing Address - Phone:478-662-2710
Mailing Address - Fax:478-333-2985
Practice Address - Street 1:104 WHITING WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6481
Practice Address - Country:US
Practice Address - Phone:478-662-2710
Practice Address - Fax:478-333-2985
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 79001041C0700X
GACSW0035841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical