Individual
MR. MARK HENDERSON DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
5384 STREET NE, COMMUNITY OPTIONS FRIDLEY, FRIDLEY, MN 55421
(763) 572-0004
(763) 572-1295
Mailing address
5384 STREET NE, COMMUNITY OPTIONS FRIDLEY, FRIDLEY, MN 55421
(763) 572-0004
(763) 572-1295
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3796
MN
Other
Enumeration date
09/03/2013
Last updated
09/03/2013
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