Provider Demographics
NPI:1629116876
Name:DAVIS, PATRICIA MARIE (CADC II, QMHA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CADC II, QMHA
Other - Prefix:MRS
Other - First Name:TRISH
Other - Middle Name:MARIE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADCII
Mailing Address - Street 1:1585 BARNES AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-1055
Mailing Address - Country:US
Mailing Address - Phone:503-399-8900
Mailing Address - Fax:
Practice Address - Street 1:1585 BARNES AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-1055
Practice Address - Country:US
Practice Address - Phone:503-399-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR99-03-47101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)