Basic Information
| Provider Information | |||||||||
| NPI: | 1013200070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | CHRISTINA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1043 CORONATION DR | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303382611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708339052 | ||||||||
| FaxNumber: | 4042923848 | ||||||||
| Practice Location | |||||||||
| Address1: | 465 WINN WAY | ||||||||
| Address2: | SUITE 221 | ||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042923810 | ||||||||
| FaxNumber: | 4042923848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2011 | ||||||||
| LastUpdateDate: | 05/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC 004717 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.