MEDICARE: VICKIE LEIGH DAVIS CDCA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		OH

General Provider Information

NPI Number	:	1699361766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIE LEIGH DAVIS CDCA

Provider Business Mailing Address
First Line	:	324 NINE MILE RD
Second Line	:
City	:	SAINT MARYS
State	:	WV
Zip	:	26170
Country	:	US
Telephone Number	:	304-615-3108
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 COUNTY HOUSE LN
Second Line	:
City	:	MARIETTA
State	:	OH
Zip	:	45750-6979
Country	:	US
Telephone Number	:	304-615-3108
Fax Number	:

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

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	12/14/2020

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