Individual provider Active NPI

Thomas C Davidson, CDP

  • Addiction (Substance Use Disorder) Counselor
  • Yakima, WA
National Provider Identifier
1003382409
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CP00000646 Issued in WA
Practice address
12 S 8TH St
Yakima, WA 98901-3020
Phone
(509) 454-4143
NPI assigned
Oct 23, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X CP00000646 WA
Addiction (Substance Use Disorder) Counselor 101YA0400X CP00000646 WA Primary

Addresses

Primary practice location

12 S 8TH St
Yakima, WA 98901-3020

Mailing address

12 S 8TH St
Yakima, WA 98901-3020
Phone (509) 454-4143

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CP00000646WAMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1003382409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 S 8TH ST",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989013020",
            "telephone_number": "509-454-4143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 S 8TH ST",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989013020",
            "telephone_number": "509-454-4143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "THOMAS",
        "middle_name": "C",
        "credential": "CDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-23",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "WA",
            "license": "CP00000646",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00000646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.