Healthcare Provider Details

I. General information

NPI: 1780088054
Provider Name (Legal Business Name): A. DAVIS, MSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W ELMWOOD DR SUITE 202
CENTERVILLE OH
45459-4239
US

IV. Provider business mailing address

1784 RIVERWOOD TRL
KINGS MILLS OH
45034-9766
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-0700
  • Fax: 937-424-5749
Mailing address:
  • Phone: 513-310-7293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1101155.SUPV
License Number StateOH

VIII. Authorized Official

Name: MS. ANNETTA J DAVIS
Title or Position: PRESIDENT
Credential: M.S.W., L.I.S.W. - S
Phone: 513-310-7293