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General NPI Number Information
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NPI Number | 1841506276
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Entity Type | Individual
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Provider Name | WALTER E DAVIS BS/ICCJP/ICCDP
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Gender | Male
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Dates
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Enumeration Date | 08/23/2010
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 4728 OXFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-5835
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Country | US
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Telephone | 215-391-8921
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Fax |
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Provider Business Mailing Address
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Address Line | 7419 BARCLAY RD
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City | CHELTENHAM
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State | PA
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Zip | 19012-1302
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Country | US
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Telephone | 215-281-8458
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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 |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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