Provider Demographics
NPI:1639354491
Name:DAVIS, ANGELA G
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BELLE HELENE CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8072
Mailing Address - Country:US
Mailing Address - Phone:337-280-3372
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 380
Practice Address - Street 2:
Practice Address - City:CADE
Practice Address - State:LA
Practice Address - Zip Code:70519-0380
Practice Address - Country:US
Practice Address - Phone:337-365-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4772101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor