| NPI | 1467696419 |
|---|---|
| Former Name | STACI DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4519) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 017898) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2024-06-12 |