Provider Demographics
NPI:1033441787
Name:DAVIS, SHERWIN L (BCBA)
Entity Type:Individual
Prefix:MR
First Name:SHERWIN
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GREENVILLE BLVD SE
Mailing Address - Street 2:STE. B-1
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5758
Mailing Address - Country:US
Mailing Address - Phone:252-341-4192
Mailing Address - Fax:866-309-9297
Practice Address - Street 1:1505 BLACKBOARD DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-1707
Practice Address - Country:US
Practice Address - Phone:757-902-9022
Practice Address - Fax:866-309-9297
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-04-1667103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst