Individual
BROOKE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 N HIGH ST, WAVERLY, OH 45690
(740) 947-7581
Mailing address
313 W 6TH ST, WAVERLY, OH 45690-1604
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.164694
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.161879
OH
101YM0800X
Mental Health Counselor
QMHS
OH
Other
Enumeration date
11/08/2017
Last updated
05/31/2019
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