Provider Demographics
NPI:1790990224
Name:DAVIS, ERIC SAMUEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:SAMUEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:SAMUEL
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW, CADCIII,
Mailing Address - Street 1:608 LANCASTER DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5643
Mailing Address - Country:US
Mailing Address - Phone:503-877-1995
Mailing Address - Fax:503-877-1995
Practice Address - Street 1:608 LANCASTER DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5643
Practice Address - Country:US
Practice Address - Phone:503-877-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR78431041C0700X
OR14-04-26101YA0400X
ORA49131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)