=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407332083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORKEEM DAVIS GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2018
-----------------------------------------------------
Last Update Date | 07/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 261 EVERETT PL
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-1661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-277-6900
-----------------------------------------------------
Fax | 201-492-5010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 261 EVERETT PL
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07631-1661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-277-6900
-----------------------------------------------------
Fax | 201-492-5010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OWNER
-----------------------------------------------------
Name | MR. ORKEEM DAVIS
-----------------------------------------------------
Credential | LPC, LCADC
-----------------------------------------------------
Telephone | 609-277-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00541500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------