Provider Demographics
NPI:1912610668
Name:DAVIS, NASHEA (LCDC III)
Entity Type:Individual
Prefix:
First Name:NASHEA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 SCARBORO ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3338
Mailing Address - Country:US
Mailing Address - Phone:937-972-1269
Mailing Address - Fax:
Practice Address - Street 1:4940 CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3619
Practice Address - Country:US
Practice Address - Phone:937-310-1269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)