Provider Demographics
NPI:1437717410
Name:DAVIS, OKICHIE M (LPC, LCPC, ACS, NCC)
Entity Type:Individual
Prefix:
First Name:OKICHIE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC, LCPC, ACS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 E ROOSEVELT BLVD STE 3
Mailing Address - Street 2:#1476
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2300
Mailing Address - Country:US
Mailing Address - Phone:215-469-1356
Mailing Address - Fax:
Practice Address - Street 1:1315 SPRUCE ST STE 222
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4701
Practice Address - Country:US
Practice Address - Phone:215-469-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional