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NPI Code Detail

MEDICARE: DENISE BALDWIN DAVIS LCDC111

MEDICARE: DENISE BALDWIN DAVIS LCDC111
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) Counselor

General Provider Information

NPI Number : 1861902447
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENISE BALDWIN DAVIS LCDC111
Provider Business Mailing Address
First Line : 3638 W LINCOLNSHIRE BLVD
Second Line :
City : TOLEDO
State : OH
Zip : 43606-1111
Country : US
Telephone Number : 718-924-1562
Fax Number :
Provider Business Practice Location Address
First Line : 3518 MONROE ST
Second Line :
City : TOLEDO
State : OH
Zip : 43606-4114
Country : US
Telephone Number : 419-241-2182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2017
Last Update Date : 10/09/2017

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Directions to “ DENISE BALDWIN DAVIS LCDC111” Practice Location

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