Provider Demographics
NPI:1790273720
Name:DAVIS, JOHN PATRICK (LCSW, LCADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4818 GREEN ASH LN
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2848
Mailing Address - Country:US
Mailing Address - Phone:609-703-4720
Mailing Address - Fax:
Practice Address - Street 1:10 E NEW YORK AVE STE 1
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2367
Practice Address - Country:US
Practice Address - Phone:609-703-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00224500101YA0400X
NJ44SC058079001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)