Provider Demographics
NPI:1053727511
Name:DAVIS, MARNIE (MA, LMHC, CEDS)
Entity type:Individual
Prefix:
First Name:MARNIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LMHC, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 LOUISIANA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2352
Mailing Address - Country:US
Mailing Address - Phone:407-252-6811
Mailing Address - Fax:321-972-5003
Practice Address - Street 1:1177 LOUISIANA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2352
Practice Address - Country:US
Practice Address - Phone:407-252-6811
Practice Address - Fax:321-972-5003
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-05
Last Update Date:2014-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health