Individual
BERNETHA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6 DUNEAN ST, GREENVILLE, SC 29611-6089
(864) 593-1133
Mailing address
120 E 5TH NORTH ST, SUMMERVILLE, SC 29483-6822
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891795738
THE PHOENIX CENTER
SC
Enumeration date
07/30/2021
Last updated
08/22/2023
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