Provider Demographics
NPI:1841506276
Name:DAVIS, WALTER E (BS/ICCJP/ICCDP)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BS/ICCJP/ICCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7419 BARCLAY RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1302
Mailing Address - Country:US
Mailing Address - Phone:215-281-8458
Mailing Address - Fax:
Practice Address - Street 1:4728 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-5835
Practice Address - Country:US
Practice Address - Phone:215-391-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)