Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003379611 |
---|---|
Provider Name | Nichole Davis |
First Address | Cedar Rapids, IA 52404-5070 |
Second Address | Cedar Rapids, IA 52404-5070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2019 |
Last Update Date | 10/04/2019 |