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NPI Code Detail

MEDICARE: CARL W DAVIS JR.

MEDICARE: CARL W DAVIS JR.
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
1101YA0400XAddiction (Substance Use Disorder) CounselorOH
2171M00000XCase Manager/Care Coordinator
3101YM0800XMental Health CounselorOH

General Provider Information

NPI Number : 1346049012
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARL W DAVIS JR.
Provider Business Mailing Address
First Line : PO BOX 402
Second Line :
City : WHEELERSBURG
State : OH
Zip : 45694-0402
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8308 OHIO RIVER RD STE B
Second Line :
City : WHEELERSBURG
State : OH
Zip : 45694-1713
Country : US
Telephone Number : 740-529-1201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2025
Last Update Date : 12/02/2025

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