Healthcare Provider Details

I. General information

NPI: 1841433356
Provider Name (Legal Business Name): MARIE JANELLE DAVIS MA, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CINCINNATI BATAVIA PIKE
CINCINNATI OH
45244-1557
US

IV. Provider business mailing address

8540 HALLRIDGE CT
CINCINNATI OH
45231-5715
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 513-628-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0700846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: