Provider Demographics
NPI:1215065008
Name:DAVIS, AL ZACHERY III
Entity type:Individual
Prefix:
First Name:AL
Middle Name:ZACHERY
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7967 RENTON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4433
Mailing Address - Country:US
Mailing Address - Phone:206-954-2636
Mailing Address - Fax:
Practice Address - Street 1:1323 YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4457
Practice Address - Country:US
Practice Address - Phone:253-502-2696
Practice Address - Fax:253-502-2757
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911585652OtherTAX IDENTIFICATION