| NPI | 1255906558 |
|---|---|
| Former Name | NICOLE DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-11-10947) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR TG-24-260) |
| 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHA-1-004670) | |
| 175T00000X Peer Specialist (Licence: OR 20-CRM-019) | |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2025-04-30 |