Most Relevant Information
Provider Data
| NPI Number: | 1003366337 |
| Provider Name: | LISA M DAVIS L.M.H.C., PH.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | MH4468 |
Most Important Dates
| Enumeration Date: | 10/11/2016 |
| Last Updated: | 10/11/2016 |
Provider Practice Location
351 6TH AVE W
BRADENTON
FL
342058820
Practice Location Phone/Fax
| Phone: | 9417378897 |
| Fax: |
Provider Mailing Location
351 6TH AVE W
BRADENTON
FL
342058820
Provider Mailing Phone/Fax
| Phone: | 9417378897 |
| Fax: |