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Individual
EVERETT DAVIS
Active
Individual
EVERETT DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDCII
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCII161844
OH
175T00000X
Peer Specialist
APS001511
OH
Other
Enumeration date
06/08/2020
Last updated
06/05/2023
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