Provider Demographics
NPI:1194083147
Name:DAVIS, CHARLENE MARIE
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHARLENE
Other - Middle Name:MARIE
Other - Last Name:WILSON-JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2351 BARKLEY PLACE
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747
Mailing Address - Country:US
Mailing Address - Phone:202-487-7311
Mailing Address - Fax:
Practice Address - Street 1:INTERGRATED COMMUNITY SERVICES INC
Practice Address - Street 2:6323 GEORGIA AVE NW # 106
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-487-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide