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General NPI Number Information
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NPI Number | 1588151096
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Entity Type | Individual
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Provider Name | NICHOLAS DAVIS LPCC, LCADC
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Gender | Male
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 246 POPLAR AVE STE 4C
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City | SOMERSET
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State | KY
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Zip | 42503-1701
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Country | US
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Telephone | 606-875-7097
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Fax | 606-657-9798
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Provider Business Mailing Address
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Address Line | 1751 SAWMILL RD
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City | JEFFERSONVILLE
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State | KY
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Zip | 40337-9016
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Country | US
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Telephone | 859-382-0052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 274366
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License Number State | KY
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