Provider Demographics
NPI:1962880567
Name:DAVIS, DESIREE (MA, CGACI)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, CGACI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 MACLEAY RD SE STE A
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-5801
Mailing Address - Country:US
Mailing Address - Phone:503-639-3009
Mailing Address - Fax:
Practice Address - Street 1:4060 MACLEAY RD SE
Practice Address - Street 2:STE A
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-5801
Practice Address - Country:US
Practice Address - Phone:503-214-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health