Healthcare Provider Details

I. General information

NPI: 1265121552
Provider Name (Legal Business Name): NORA CATHLEEN DAVIS LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NORA CATHLEEN FLAHERTY

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 ANTHONY LN S STE 201
SAINT ANTHONY MN
55418-2637
US

IV. Provider business mailing address

2855 ANTHONY LN S STE 201
SAINT ANTHONY MN
55418-2637
US

V. Phone/Fax

Practice location:
  • Phone: 651-217-1480
  • Fax:
Mailing address:
  • Phone: 651-217-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306488
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5557
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: