Provider Demographics
NPI:1891249223
Name:DAVIS, HOLLI (CSCAD, PROV)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CSCAD, PROV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:EARLEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21919-2353
Mailing Address - Country:US
Mailing Address - Phone:443-945-1466
Mailing Address - Fax:
Practice Address - Street 1:516 WASHINGTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1225
Practice Address - Country:US
Practice Address - Phone:443-988-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT903101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)