Individual
MR. DEMETRICK LEWAYNE DAVIS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3208 NE OVERBROOK DR, OKLAHOMA CITY, OK 73121-2853
(405) 885-3651
Mailing address
3208 N.E. OVERBROOK DR., OKLAHOMA CITY, OK 73121
(405) 885-3651
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345678
OKLAHOMA DEPT. OF MENTAL HEALTH
OK
Enumeration date
06/06/2012
Last updated
06/06/2012
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