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NPI Code Detail

MEDICARE: ANDREA DAVIS MA

MEDICARE: ANDREA DAVIS MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YA0400XAddiction (Substance Use Disorder) Counselor
3106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1164870473
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA DAVIS MA
Provider Business Mailing Address
First Line : 4524 SE 35TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97202-3322
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1498 SE TECH CENTER PL STE 180
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-5518
Country : US
Telephone Number : 360-619-2226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2016
Last Update Date : 12/09/2022

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Directions to “ ANDREA DAVIS MA” Practice Location

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