Provider Demographics
NPI:1700600574
Name:DAVIS, HOWARD L
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REGION 12 CTC 2157 GREENBRIER ST
Mailing Address - Street 2:2157 GREENBRIER STREET
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311
Mailing Address - Country:US
Mailing Address - Phone:304-344-5924
Mailing Address - Fax:304-344-3503
Practice Address - Street 1:REGION 12 CTC 2157 GREENBRIER ST
Practice Address - Street 2:2157 GREENBRIER STREET
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311
Practice Address - Country:US
Practice Address - Phone:304-344-5924
Practice Address - Fax:304-344-3503
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)