Individual
TERESA R DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRC
Contact information
Practice address
1700 E 38TH ST, MARION, IN 46953-4568
(765) 674-3321
Mailing address
2506 W 800 S, WARREN, IN 46792-9258
(260) 468-2446
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C 043780
IL
Other
Enumeration date
09/27/2006
Last updated
07/08/2007
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