Provider Demographics
NPI:1780088054
Name:A. DAVIS, MSW, LLC
Entity type:Organization
Organization Name:A. DAVIS, MSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW - S
Authorized Official - Phone:513-310-7293
Mailing Address - Street 1:1784 RIVERWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:KINGS MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:45034-9766
Mailing Address - Country:US
Mailing Address - Phone:513-310-7293
Mailing Address - Fax:
Practice Address - Street 1:77 W ELMWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4239
Practice Address - Country:US
Practice Address - Phone:937-436-0700
Practice Address - Fax:937-424-5749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1101155.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty