Provider Demographics
NPI:1407355001
Name:DAVIS, CLEASTER SR (SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:CLEASTER
Middle Name:
Last Name:DAVIS
Suffix:SR
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 EXECUTIVE DR STE O
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4361
Mailing Address - Country:US
Mailing Address - Phone:317-672-2621
Mailing Address - Fax:
Practice Address - Street 1:1811 EXECUTIVE DR STE O
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4361
Practice Address - Country:US
Practice Address - Phone:317-672-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
33001935A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker