Provider Demographics
NPI:1033688742
Name:DAVIS, TREVOR C (LSW, LCDC-III)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LSW, LCDC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6797 N HIGH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2533
Mailing Address - Country:US
Mailing Address - Phone:877-828-3889
Mailing Address - Fax:614-888-3239
Practice Address - Street 1:6797 N HIGH ST STE 350
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2533
Practice Address - Country:US
Practice Address - Phone:877-828-3889
Practice Address - Fax:614-888-3239
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161777101YA0400X
OHS.1802280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)