Healthcare Provider Details

I. General information

NPI: 1518130087
Provider Name (Legal Business Name): ORKEEM DAVIS LPC, LCADC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 EVERETT PL
ENGLEWOOD NJ
07631-1661
US

IV. Provider business mailing address

261 EVERETT PL
ENGLEWOOD NJ
07631-1661
US

V. Phone/Fax

Practice location:
  • Phone: 609-277-6900
  • Fax: 201-492-5010
Mailing address:
  • Phone: 609-277-6900
  • Fax: 201-492-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00243800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00541500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: