Healthcare Provider Details

I. General information

NPI: 1861087934
Provider Name (Legal Business Name): NICKY DAVIS MSW, CTRS/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 JENKINS CT
DURHAM NH
03824-2323
US

IV. Provider business mailing address

121 TECHNOLOGY DR
DURHAM NH
03824-4721
US

V. Phone/Fax

Practice location:
  • Phone: 978-413-4104
  • Fax:
Mailing address:
  • Phone: 603-862-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number0138
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: