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General NPI Number Information
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NPI Number | 1740087410
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Entity Type | Individual
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Provider Name | JAVONTE DAVIS LMSW
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Gender | Male
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 6541 SPECKER AVE
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City | FORT CARSON
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State | CO
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Zip | 80913-4263
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Country | US
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Telephone | 843-304-8252
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Fax |
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Provider Business Mailing Address
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Address Line | 119 RIDGE RD
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City | DARLINGTON
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State | SC
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Zip | 29532-5913
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Country | US
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Telephone | 843-304-8252
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW-3195
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 15123
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License Number State | SC
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