Provider Information for 1407464639
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KASHUNDA LACHE DAVIS LPC
Sex: Female
NPI: 1407464639
Last Updated: 2023-06-02
Certification Date: 2023-06-02
Certification Date: 2023-06-02
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1407464639 | ||||||||
| Enumeration Date | 2020-07-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 620 TERESA LN GRAND PRAIRIE, TX 75052-2815 United States Phone: 214-836-3957 | Fax: | ||||||||
| Primary Practice Address | 610 UPTOWN BLVD FL 2 CEDAR HILL, TX 75104-3527 United States Phone: 844-824-8775 | Fax:281-648-2200 | ||||||||
| Secondary Practice Address(es) | 200 S 14TH ST STE 150 | ||||||||
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