Provider Demographics
NPI:1992175426
Name:TERASA L. DAVIS, PSY.D., PC
Entity type:Organization
Organization Name:TERASA L. DAVIS, PSY.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERASA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:205-391-9777
Mailing Address - Street 1:5690 WATERMELON RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5004
Mailing Address - Country:US
Mailing Address - Phone:205-391-9777
Mailing Address - Fax:205-391-9766
Practice Address - Street 1:5690 WATERMELON RD
Practice Address - Street 2:SUITE 310
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5004
Practice Address - Country:US
Practice Address - Phone:205-391-9777
Practice Address - Fax:205-391-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL906251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-23502OtherBCBS
AL890010770Medicaid
AL515-23502OtherBCBS