Healthcare Provider Details

I. General information

NPI: 1477207066
Provider Name (Legal Business Name): HEATHER DAVIS LCDC II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S SOUTH ST
WILMINGTON OH
45177-2755
US

IV. Provider business mailing address

244 ROSHON RD
SABINA OH
45169-9215
US

V. Phone/Fax

Practice location:
  • Phone: 937-910-6218
  • Fax: 800-480-9678
Mailing address:
  • Phone: 937-728-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: