Provider Demographics
NPI:1710456090
Name:DAVIS, CECIL CHADWICK (EDD, ALC)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:CHADWICK
Last Name:DAVIS
Suffix:
Gender:M
Credentials:EDD, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5258
Mailing Address - Country:US
Mailing Address - Phone:205-563-1328
Mailing Address - Fax:
Practice Address - Street 1:423 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5258
Practice Address - Country:US
Practice Address - Phone:205-563-1328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
AL3244101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health