Provider Demographics
NPI:1902454895
Name:DAVIS, CHRISTINE COLEMAN (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:COLEMAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-8228
Mailing Address - Country:US
Mailing Address - Phone:334-494-6178
Mailing Address - Fax:
Practice Address - Street 1:1311 RUCKER BLVD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2234
Practice Address - Country:US
Practice Address - Phone:334-417-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor