Provider Demographics
NPI:1093031890
Name:DAVIS, JAMES E III (LPCC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5756 WILLOWDALE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8910
Mailing Address - Country:US
Mailing Address - Phone:937-323-0951
Mailing Address - Fax:937-933-4050
Practice Address - Street 1:825 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1198
Practice Address - Country:US
Practice Address - Phone:937-323-0951
Practice Address - Fax:937-933-4050
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0000731101Y00000X, 101YA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1265764692OtherGROUP NPI