Individual
MR. DONALD DAVIS I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC, CADAC II
Contact information
Practice address
990 ILLINOIS ST, PLYMOUTH, IN 46563-3622
(574) 936-9646
(574) 935-4773
Mailing address
850 N HARRISON ST, WARSAW, IN 46580-3163
(574) 267-7169
(574) 269-5573
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
86000001A
IN
101YA0400X
Addiction (Substance Use Disorder) Counselor
CII-1433
IN
Other
Enumeration date
10/14/2013
Last updated
10/14/2013
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