Provider Demographics
NPI:1902078876
Name:JOSEPH-DAVISAM, SHIRLEY (GSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:JOSEPH-DAVISAM
Suffix:
Gender:F
Credentials:GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19404 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8892
Mailing Address - Country:US
Mailing Address - Phone:985-871-1380
Mailing Address - Fax:
Practice Address - Street 1:19404 N 10TH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8892
Practice Address - Country:US
Practice Address - Phone:985-871-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9653101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)