Provider Demographics
NPI:1053034934
Name:DAVIS, CARRISA (LMSW)
Entity type:Individual
Prefix:MS
First Name:CARRISA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CARRISA
Other - Middle Name:
Other - Last Name:ZAJAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2408 TRAVERSE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-8007
Mailing Address - Country:US
Mailing Address - Phone:575-430-3987
Mailing Address - Fax:
Practice Address - Street 1:BLDG 36065 590 MEDICAL CENTER RD.
Practice Address - Street 2:3RD FLOOR, RM 33-133
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-0651104100000X
TX111665104100000X
NMSWB-2023-0595104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker