Doctor Name: | BRIAN DAVIS |
NPI Number: | 1003934084 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A. |
License Number: | 0680000439 |
Business Practice Address: | 16 Town Crier Dr Suite 1 Brattleboro, VT - 053018669 |
Business Phone Number: | 8022584629 |
Business Fax Number: | |
Mailing Address: | Po Box 1664, WILMINGTON |
State: | VT |
Postal Code: | 053631664 |
Phone Number: | 8025982900 |
Fax Number: | |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 0680000439 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |