Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | MH13650 | FL |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 5590 | FL |
N | 101YM0800X | Mental Health Counselor | MH13650 | FL |
Y | 101YP2500X | Professional Counselor | MH13650 | FL |
N | 101YS0200X | School Counselor | MH13650 | FL |
NPI | 1245605492 |
---|---|
Provider Name | John Avery Davis III |
First Address | Jacksonville, FL 32216-8029 |
Second Address | Jacksonville, FL 32216-8029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2015 |
Last Update Date | 14/12/2015 |