Provider Demographics
NPI:1407293681
Name:DAVIS-PERRY, LAURA I (LISW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:I
Last Name:DAVIS-PERRY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:I
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:6810 EAST MAIN STREET
Mailing Address - Street 2:SUITE 201 - 4
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1625
Mailing Address - Country:US
Mailing Address - Phone:614-357-0686
Mailing Address - Fax:
Practice Address - Street 1:6810 EAST MAIN STREET
Practice Address - Street 2:SUITE 201 - 4
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1625
Practice Address - Country:US
Practice Address - Phone:614-357-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.17003801041C0700X
OHS.1450489104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid