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1154838290
MILES ERNEST DAVISON
ROANOKE, VA
NPI
1154838290
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: VA 0904010320)
Enumeration Date
2018-01-10
Last Update Date
2018-01-10
Business Address
MILES ERNEST DAVISON LCSW
1719 GRANDIN RD SW
ROANOKE, VA 24015-2815
Phone number: 215-840-5034
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Mailing Address
MILES ERNEST DAVISON LCSW
2049 WINDSOR AVE SW APT 4
ROANOKE, VA 24015-2331
Phone number: 215-840-5034
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