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General NPI Number Information
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NPI Number | 1881826337
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Entity Type | Individual
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Provider Name | ANNETTA JEAN DAVIS LISW-S
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Gender | Female
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 02/09/2019
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Provider Practice Location Address
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Address Line | 7950 CLYO ROAD
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 513-310-7293
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Fax | 937-938-5249
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Provider Business Mailing Address
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Address Line | 7950 CLYO RD
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City | CENTERVILLE
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State | OH
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Zip | 45459
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Country | US
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Telephone | 513-310-7293
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Fax | 937-938-5249
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1101155
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License Number State | OH
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