Provider Demographics
NPI:1598193369
Name:DAVIS, DONALD I (LAC, CADAC II)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:DAVIS
Suffix:I
Gender:M
Credentials:LAC, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3163
Mailing Address - Country:US
Mailing Address - Phone:574-267-7169
Mailing Address - Fax:574-269-5573
Practice Address - Street 1:990 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-3622
Practice Address - Country:US
Practice Address - Phone:574-936-9646
Practice Address - Fax:574-935-4773
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000001A101YA0400X
INCII-1433101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)