Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS005967L | PA |
Y | 103TC0700X | Clinical Psychologist | PS005967L | PA |
N | 103TC1900X | Counseling Psychologist | 699 | WV |
NPI | 1063839017 |
---|---|
Provider Name | James Eric Davison |
First Address | Grantsville, WV 26147-7100 |
Second Address | Grantsville, WV 26147-7100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
699 | STATE LICENSE (01) | WV |