Provider Demographics
NPI:1114131125
Name:DAVIS, VIVIAN ANN (MSW, LCSW CACII)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW, LCSW CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 MELODY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-4119
Mailing Address - Country:US
Mailing Address - Phone:720-975-7371
Mailing Address - Fax:720-362-5213
Practice Address - Street 1:10465 MELODY DR
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4119
Practice Address - Country:US
Practice Address - Phone:720-975-7371
Practice Address - Fax:720-362-5213
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9391041C0700X
COACB0006428101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)