Healthcare Provider Details

I. General information

NPI: 1326586660
Provider Name (Legal Business Name): PATRICIA DAVIS LSW, LCDC III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N HIGH ST
COLUMBUS OH
43201-2460
US

IV. Provider business mailing address

1301 N HIGH ST
COLUMBUS OH
43201-2460
US

V. Phone/Fax

Practice location:
  • Phone: 614-299-6600
  • Fax:
Mailing address:
  • Phone: 614-299-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number964531
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0030087
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: