Provider Demographics
NPI:1962727305
Name:DAVIS, OLIVER JAMES JR (MSW, LCSW, LMSW)
Entity type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:JAMES
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MSW, LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 N MAIN ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9681
Mailing Address - Country:US
Mailing Address - Phone:574-876-6938
Mailing Address - Fax:574-931-2679
Practice Address - Street 1:6910 N MAIN ST UNIT 4
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530
Practice Address - Country:US
Practice Address - Phone:574-876-6938
Practice Address - Fax:574-931-2679
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010668291041C0700X
IN34003612A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical