Provider Demographics
NPI:1043758808
Name:DAVIDSON, JAY POWELL (LCSW, ADCLAD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:POWELL
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:LCSW, ADCLAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2630
Mailing Address - Country:US
Mailing Address - Phone:502-584-7844
Mailing Address - Fax:502-587-9565
Practice Address - Street 1:1017 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2630
Practice Address - Country:US
Practice Address - Phone:502-357-1986
Practice Address - Fax:502-587-9565
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00223665101YA0400X
KY08751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0875OtherKENTUCKY BOARD OF SOCIAL WORK
KY0875OtherKENTUCKY BOARD OF SOCIAL WORK