Provider Demographics
NPI:1275011900
Name:DAVIS, BLAIR J (PSYD)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 SHAWMONT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4045
Mailing Address - Country:US
Mailing Address - Phone:215-259-8821
Mailing Address - Fax:
Practice Address - Street 1:EVERGREEN COUNSELING & PSYCHOLOGICAL ASSOC
Practice Address - Street 2:TOP OF THE HILL PLAZA, 8705 GERMANTOWN AVE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118
Practice Address - Country:US
Practice Address - Phone:215-247-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24930103TC0700X
PAPS019461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical