Provider Demographics
NPI:1750969754
Name:DAVIS, MARILYN GRANVILLE (PHD , LCSW, PIP)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:GRANVILLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD , LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ROYAL CREST DR APT H106
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-6457
Mailing Address - Country:US
Mailing Address - Phone:256-483-3200
Mailing Address - Fax:
Practice Address - Street 1:300 ROYAL CREST DR APT H106
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-6457
Practice Address - Country:US
Practice Address - Phone:256-483-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2023C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical