Provider Demographics
NPI:1174339063
Name:DAVIS, ALLISON (LSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 STATE ROUTE 106
Mailing Address - Street 2:
Mailing Address - City:UNION DALE
Mailing Address - State:PA
Mailing Address - Zip Code:18470-7404
Mailing Address - Country:US
Mailing Address - Phone:570-396-6101
Mailing Address - Fax:
Practice Address - Street 1:320 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1590
Practice Address - Country:US
Practice Address - Phone:570-351-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW141029104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker