Individual
MR. CHANAN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
700 AIRPORT RD, LAKEWOOD, NJ 08701-5907
(732) 367-4700
Mailing address
700 AIRPORT RD, LAKEWOOD, NJ 08701-5907
(732) 367-4700
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
37F100187200
NJ
106H00000X
Marriage & Family Therapist
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029807
—
NJ
Enumeration date
02/06/2015
Last updated
10/10/2018
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