Provider Demographics
NPI:1184279002
Name:DAVIS, DAZZMEN N (LCMHC, LPC)
Entity type:Individual
Prefix:
First Name:DAZZMEN
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CHESHIRE BRIDGE RD NE UNIT 1608
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4364
Mailing Address - Country:US
Mailing Address - Phone:404-649-5274
Mailing Address - Fax:404-726-4881
Practice Address - Street 1:2050 CHESHIRE BRIDGE RD NE UNIT 1608
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4364
Practice Address - Country:US
Practice Address - Phone:910-964-9498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15072101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional