Provider Demographics
NPI:1851576367
Name:DAVIS, ANDREW J (MSED, PCC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MSED, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1209
Mailing Address - Country:US
Mailing Address - Phone:330-715-1368
Mailing Address - Fax:
Practice Address - Street 1:777 W MARKET ST STE C3
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1092
Practice Address - Country:US
Practice Address - Phone:330-715-1368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0007707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional