Individual
NICOLE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW, LADC
Contact information
Practice address
940 HASTINGS AVE, ST PAUL PARK, MN 55071-1315
(651) 354-0430
Mailing address
940 HASTINGS AVE, ST PAUL PARK, MN 55071-1315
(612) 608-9068
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304395
MN
101YM0800X
Mental Health Counselor
Primary
27532
MN
Other
Enumeration date
06/24/2018
Last updated
10/30/2025
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