Provider Demographics
NPI:1396046629
Name:DAVIS, PRINCESS JANESA (SOCIAL WORKER)
Entity type:Individual
Prefix:MRS
First Name:PRINCESS
Middle Name:JANESA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:MS
Other - First Name:PRINCESS
Other - Middle Name:JANESA
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5050 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1491
Mailing Address - Country:US
Mailing Address - Phone:513-272-2800
Mailing Address - Fax:513-272-2807
Practice Address - Street 1:5050 MADISON RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227
Practice Address - Country:US
Practice Address - Phone:513-272-2800
Practice Address - Fax:513-272-2807
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1700146104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker