Provider Demographics
NPI:1245605492
Name:DAVIS, JOHN AVERY III (LMHC, CAP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AVERY
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 SALISBURY RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8029
Mailing Address - Country:US
Mailing Address - Phone:904-353-2949
Mailing Address - Fax:904-374-6590
Practice Address - Street 1:4237 SALISBURY RD
Practice Address - Street 2:SUITE 308
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8029
Practice Address - Country:US
Practice Address - Phone:904-353-2949
Practice Address - Fax:904-374-6590
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13650101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X
FL5590101YA0400X
FLPMD509652146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic