Healthcare Provider Details

I. General information

NPI: 1700600574
Provider Name (Legal Business Name): HOWARD L DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REGION 12 CTC 2157 GREENBRIER ST 2157 GREENBRIER STREET
CHARLESTON WV
25311
US

IV. Provider business mailing address

REGION 12 CTC 2157 GREENBRIER ST 2157 GREENBRIER STREET
CHARLESTON WV
25311
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-5924
  • Fax: 304-344-3503
Mailing address:
  • Phone: 304-344-5924
  • Fax: 304-344-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: