Individual
JEFFERY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MLADC
Contact information
Practice address
1555 ELM ST, MANCHESTER, NH 03101-1203
(603) 668-4111
(603) 628-7757
Mailing address
2 WALL ST STE 300, MANCHESTER, NH 03101-1518
(603) 668-4111
(603) 628-7757
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0578
NH
101YA0400X
Addiction (Substance Use Disorder) Counselor
0939
NH
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2163087
CIGNA
NH
01
—
7706660Y0NH01
BLUE CROSS
NH
Enumeration date
11/30/2006
Last updated
03/22/2021
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