Provider Demographics
NPI:1639798564
Name:DAVIS, BRITAIN KALOB (RADT)
Entity Type:Individual
Prefix:
First Name:BRITAIN
Middle Name:KALOB
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-1332
Mailing Address - Country:US
Mailing Address - Phone:707-445-0869
Mailing Address - Fax:
Practice Address - Street 1:1205 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1224
Practice Address - Country:US
Practice Address - Phone:707-445-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)