Provider Demographics
NPI:1992161590
Name:DAVIS, NEAL EUGENE JR (LICDC)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:EUGENE
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2841
Mailing Address - Country:US
Mailing Address - Phone:419-535-3214
Mailing Address - Fax:419-535-6794
Practice Address - Street 1:2450 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2841
Practice Address - Country:US
Practice Address - Phone:419-535-3214
Practice Address - Fax:419-535-6794
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH965733101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)