Provider Demographics
NPI:1679953665
Name:DAVIDSON, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 DELSEA DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08322
Mailing Address - Country:US
Mailing Address - Phone:856-694-4050
Mailing Address - Fax:856-694-3717
Practice Address - Street 1:987 DELSEA DR
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08322-2313
Practice Address - Country:US
Practice Address - Phone:856-694-4050
Practice Address - Fax:856-694-3717
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health