Healthcare Provider Details

I. General information

NPI: 1376496745
Provider Name (Legal Business Name): JOSEPH DAVIDSON MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W SUPERIOR ST
DULUTH MN
55802-1938
US

IV. Provider business mailing address

222 W SUPERIOR ST
DULUTH MN
55802-1938
US

V. Phone/Fax

Practice location:
  • Phone: 218-606-1100
  • Fax:
Mailing address:
  • Phone: 218-606-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2992
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: