=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588805154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EILEEN SHERYL DAVIS CDP, RC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2009
-----------------------------------------------------
Last Update Date | 03/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9415 E TRENT AVE
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99206-4218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-926-3361
-----------------------------------------------------
Fax | 509-927-8420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9415 E TRENT AVE
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99206-4218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-926-3361
-----------------------------------------------------
Fax | 509-927-8420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CP 00005603
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | RC 00044003
-----------------------------------------------------
License Number State |
-----------------------------------------------------