Provider Demographics
NPI:1942633649
Name:DAVIS, DAVID MICHAEL (CADCII, CDP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CADCII, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 SW WESTGATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-2406
Mailing Address - Country:US
Mailing Address - Phone:503-231-2641
Mailing Address - Fax:
Practice Address - Street 1:5415 SW WESTGATE DRIVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2409
Practice Address - Country:US
Practice Address - Phone:503-231-2641
Practice Address - Fax:503-629-6517
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCADCII 98-04-12101YA0400X
WACDP CP60253363101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)