Provider Demographics
NPI:1750114633
Name:DAVIS, ALICIA MORGAN (M SPED)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MORGAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:M SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3542 KILGORE CREEK RD # NA
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541-2219
Mailing Address - Country:US
Mailing Address - Phone:304-389-0611
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:3542 KILGORE CREEK RD # NA
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541-2219
Practice Address - Country:US
Practice Address - Phone:304-389-0611
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency