Doctor Name: | MR. DAVID LEON AVERY |
NPI Number: | 1235437096 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMHC |
License Number: | 7173 |
Business Practice Address: | 35 Burt St Dorchester Center, MA - 021243705 |
Business Phone Number: | 6172829772 |
Business Fax Number: | 6175061573 |
Mailing Address: | 35 Burt St, DORCHESTER CENTER |
State: | MA |
Postal Code: | 021243705 |
Phone Number: | 6172829772 |
Fax Number: | 6175061573 |
NPI Enumeration Date: | 03/03/2011 |
NPI Last Update Date: | 03/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 7173 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |