Provider Demographics
NPI:1174774111
Name:DAVIS, ANGELA L
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALC
Mailing Address - Street 1:1302 NOBLE ST
Mailing Address - Street 2:SUITE 2H
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-4693
Mailing Address - Country:US
Mailing Address - Phone:256-238-0980
Mailing Address - Fax:256-237-1652
Practice Address - Street 1:1302 NOBLE ST
Practice Address - Street 2:SUITE 2H
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4693
Practice Address - Country:US
Practice Address - Phone:256-238-0980
Practice Address - Fax:256-237-1652
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC607A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health