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General NPI Number Information
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NPI Number | 1679980619
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Entity Type | Individual
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Provider Name | KATHLEEN J DAVIDSON LCAC
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Gender | Female
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 322 W JEFFERSON ST
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City | PLYMOUTH
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State | IN
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Zip | 46563-1734
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Country | US
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Telephone | 574-936-3377
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Fax | 574-936-3910
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Provider Business Mailing Address
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Address Line | 8495 E 150 S
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City | KNOX
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State | IN
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Zip | 46534-8396
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Country | US
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Telephone | 219-928-1944
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Fax | 574-936-3910
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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 | 87001530A
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License Number State | IN
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