| Name: | Terasa L. Davis, Psy. D. P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 21 Aug 2015 (9 years ago) |
| Entity Number: | 000-342-950 |
| Register Number: | 000342950 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Registered Office Street Address: | 5690 WATERMELON ROAD SUITE 310NORTHPORT, AL 35473 |
| Registered Office Street Address ZIP Code: | 35473 |
| Authorized Capital: | 1000 @ $1.00 PV |
Activities
ENGAGE IN THE BUSINESS OF PSYCHOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992175426 | 2015-09-27 | 2015-09-27 | 5690 WATERMELON RD, SUITE 310, NORTHPORT, AL, 354735004, US | 5690 WATERMELON RD, SUITE 310, NORTHPORT, AL, 354735004, US | |||||||||||||||||||||||||||||||
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| Phone | +1 205-391-9777 |
| Fax | 2053919766 |
Authorized person
| Name | DR. TERASA L DAVIS |
| Role | CLINICAL PSYCHOLOGIST |
| Phone | 2053919777 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 906 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 515-23502 |
| State | AL |
| Issuer | MEDICAID |
| Number | 890010770 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| DAVIS, TERASA L | Agent | 15190 HILLVIEW ROADCOKER, AL 35452 |
| Name | Role | Address |
|---|---|---|
| DAVIS, TERASA L | Director | 15190 HILLVIEW ROADCOKER, AL 35452 |
| Name | Role | Address |
|---|---|---|
| DAVIS, TERASA L | Incorporator | 15190 HILLVIEW ROADCOKER, AL 35452 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
