Healthcare Provider Details

I. General information

NPI: 1295416253
Provider Name (Legal Business Name): DESTINY DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SULLIVANT AVE
COLUMBUS OH
43204-1837
US

IV. Provider business mailing address

3225 SULLIVANT AVE
COLUMBUS OH
43204-1837
US

V. Phone/Fax

Practice location:
  • Phone: 614-655-8956
  • Fax:
Mailing address:
  • Phone: 614-655-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2410907
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.184982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: