MEDICARE: OKICHIE M DAVIS LPC, LCPC, ACS, NCC

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
1	101YP2500X	Professional Counselor	PC011190	PA

General Provider Information

NPI Number	:	1437717410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OKICHIE M DAVIS LPC, LCPC, ACS, NCC

Provider Business Mailing Address
First Line	:	2313 E VENANGO ST. STE 4B
Second Line	:	1010
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4621
Country	:	US
Telephone Number	:	215-469-1356
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 E VENANGO ST. STE 4B
Second Line	:	#1010
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4621
Country	:	US
Telephone Number	:	215-469-1356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	03/10/2026

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