Provider Demographics
NPI:1619782810
Name:DAVIS, WENDOLYN W (SSW, MED)
Entity type:Individual
Prefix:
First Name:WENDOLYN
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NIGHT SKY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-8319
Mailing Address - Country:US
Mailing Address - Phone:575-626-0665
Mailing Address - Fax:
Practice Address - Street 1:2 NIGHT SKY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-8319
Practice Address - Country:US
Practice Address - Phone:575-626-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No104100000XBehavioral Health & Social Service ProvidersSocial Worker