Individual
AMY A DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 671-9203
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 671-9203
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1637435
—
AK
Enumeration date
06/15/2020
Last updated
03/09/2023
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