Provider Demographics
NPI:1699949602
Name:DAVIS, RICHARD STEPHEN (LCPC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEPHEN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 STATE HIGHWAY 150
Mailing Address - Street 2:
Mailing Address - City:PARKMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04443-3200
Mailing Address - Country:US
Mailing Address - Phone:207-277-3093
Mailing Address - Fax:207-277-3351
Practice Address - Street 1:967 STATE HIGHWAY 150
Practice Address - Street 2:
Practice Address - City:PARKMAN
Practice Address - State:ME
Practice Address - Zip Code:04443-3200
Practice Address - Country:US
Practice Address - Phone:207-876-2815
Practice Address - Fax:207-277-3351
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1735101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor