Healthcare Provider Details

I. General information

NPI: 1346759107
Provider Name (Legal Business Name): ANDREW DAVIS MSW, LSW, CCHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 E BROAD ST
COLUMBUS OH
43213-1279
US

IV. Provider business mailing address

270 W LAKEVIEW AVE
COLUMBUS OH
43202-1047
US

V. Phone/Fax

Practice location:
  • Phone: 380-201-1315
  • Fax: 740-964-0030
Mailing address:
  • Phone: 614-441-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.2106429
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: