Individual
GARY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMS
Contact information
Practice address
2266 WAKEFIELD MOUND RD, PIKETON, OH 45661-9660
(740) 771-7098
Mailing address
1037 STATE ROUTE 551 APT 191, WAVERLY, OH 45690-9640
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
12/16/2018
Last updated
02/09/2023
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