Davona D Blackhorse, LAC
Counselor, Mental Health in Mesa, AZ. Individual provider (NPI-1).
NPI number1043098643
StatusActive
Last updated in NPPESSep 15, 2023
Details
- NPI
- 1043098643
- Entity type
- Individual (NPI-1)
- Name
- Davona D Blackhorse
- Credential
- LAC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 15, 2023
- Certification date
- Sep 15, 2023
- Last updated
- Sep 15, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | LAC-20688 | AZ | Yes |
Practice location
2204 S Dobson Rd Ste 201Mesa, AZ 85202-6457
Phone 602-230-7373
Mailing address
3101 N Central Ave Ste 500Phoenix, AZ 85012-2639
Phone 602-230-7373
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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