Provider Demographics
NPI:1699361766
Name:DAVIS, VICKIE LEIGH (CDCA)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:WV
Mailing Address - Zip Code:26170
Mailing Address - Country:US
Mailing Address - Phone:304-615-3108
Mailing Address - Fax:
Practice Address - Street 1:750 COUNTY HOUSE LN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-6979
Practice Address - Country:US
Practice Address - Phone:304-615-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)