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NPI Code Detail

MEDICARE: DEBORAH S DAVIS LCDC

MEDICARE: DEBORAH S DAVIS LCDC
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) Counselor13249TX

General Provider Information

NPI Number : 1639705700
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH S DAVIS LCDC
Provider Business Mailing Address
First Line : PO BOX 890
Second Line :
City : WACO
State : TX
Zip : 76703-0890
Country : US
Telephone Number : 254-752-3451
Fax Number : 254-756-3133
Provider Business Practice Location Address
First Line : 2220 AUSTIN AVE
Second Line :
City : WACO
State : TX
Zip : 76701-1625
Country : US
Telephone Number : 254-752-3451
Fax Number : 254-756-3133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2020
Last Update Date : 03/20/2020

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