| Doctor Name: | DR. DEXTER JUAN DAVIS |
| NPI Number: | 1124486477 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.D LCADC |
| License Number: | 37LC00197500 |
| Business Practice Address: | 360 Stiles St Vauxhall, NJ - 070881329 |
| Business Phone Number: | 9086884462 |
| Business Fax Number: | 9086887959 |
| Mailing Address: | 360 Stiles Street, VAUXHALL |
| State: | NJ |
| Postal Code: | 07088 |
| Phone Number: | 9086884462 |
| Fax Number: | 9086887959 |
| NPI Enumeration Date: | 02/02/2016 |
| NPI Last Update Date: | 02/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 37LC00197500 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |