Provider Demographics
NPI:1073052254
Name:DAVIDSON, CHI MI YI (CDP)
Entity Type:Individual
Prefix:
First Name:CHI MI YI
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 MARTIN WAY E
Mailing Address - Street 2:BLDG A SUITE 105
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-688-7312
Mailing Address - Fax:360-688-7318
Practice Address - Street 1:3773 MARTIN WAY E
Practice Address - Street 2:BLDG A SUITE 105
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5048
Practice Address - Country:US
Practice Address - Phone:360-688-7312
Practice Address - Fax:360-688-7318
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60729036101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)