Ike Lenard Davis Jr.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

18224 Issued in CA

Practice address

160 Glen Cove Marina Rd E Ste 102
Vallejo, CA 94591-7290

Phone

(707) 648-2000

NPI assigned

Feb 23, 2022

Last updated

Dec 18, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• MSK Solutions

  dba Mile High Residential and Behavioral Health

  • Foster Care Agency
  • Vallejo, CA
  • NPI 1265023915
  NPD (past)
• MSK Solutions

  dba Mile High Residential Behavior Health Services

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Vallejo, CA
  • NPI 1437803178
  NPD (past)

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1023764594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 GLEN COVE MARINA RD E STE 102",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945917290",
            "telephone_number": "707-648-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 GLEN COVE MARINA RD E STE 102",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945917290",
            "telephone_number": "707-648-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "IKE",
        "middle_name": "LENARD",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-23",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "18224",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Barbara Davidson, R.N., P.H.N.
• Shalena Davis Wilson
• Amy J Davis, R.D, C.D.E.
• Brianna Davis
• Erica Davis
• Kiana Janelle Davis
• Lisa Davis, CNM
• Marcus Tee Davis Jr.
• Michelle Davis, MD
• Philip Michael Davis

• Mental Health Counselor in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; 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.