Provider Demographics
NPI:1346618287
Name:DAVIS, MEMORY (BA, CAC II)
Entity Type:Individual
Prefix:
First Name:MEMORY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BA, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17155 E NASSAU PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3203
Mailing Address - Country:US
Mailing Address - Phone:303-564-5304
Mailing Address - Fax:
Practice Address - Street 1:17155 E NASSAU PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-3203
Practice Address - Country:US
Practice Address - Phone:303-564-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6344101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)