Jessica Summer Davis, CSC-AD
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Edgewood, MD
NPI 1083390405 · NPPES record last updated Jun 22, 2023
Key facts
- NPI
- 1083390405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- SC2913 (MD)
- Practice address
- 1308 Business Center Way
Edgewood, MD 21040-1504 - Phone
- (443) 461-3311
- NPI assigned
- Jun 22, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SC2913 | MD | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | SC2913 | MD | Yes |
Addresses
Primary practice location
1308 Business Center Way
Edgewood, MD 21040-1504
Mailing address
1308 Business Center Way
Edgewood, MD 21040-1504
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All providers in Edgewood, MD · Addiction (Substance Use Disorder) Counselor in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.