Provider Demographics
NPI:1992419964
Name:DAVIS, NAOMI J (LCPC-C)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 FOREST AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1505
Mailing Address - Country:US
Mailing Address - Phone:207-221-0635
Mailing Address - Fax:207-221-0634
Practice Address - Street 1:550 FOREST AVE STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1505
Practice Address - Country:US
Practice Address - Phone:207-221-0635
Practice Address - Fax:207-221-0634
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6323101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health