Active NPI
Kevin Alonzo Davis, MS, LADC1, CCFC
- Addiction (Substance Use Disorder) Counselor
- Brockton, MA
National Provider Identifier
1346858347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 2415
- Practice address
- 10 Meadowbrook Rd
Brockton, MA 02301-7122 - Phone
- (508) 742-4400
- Fax
- (508) 408-6175
- NPI assigned
- Jul 16, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 2415 | MA | Primary |
Addresses
Primary practice location
10 Meadowbrook Rd
Brockton, MA 02301-7122
Mailing address
10 Meadowbrook Rd
Brockton, MA 02301-7122
Phone (508) 742-4400
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2415 | MA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594857600000",
"number": "1346858347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 MEADOWBROOK RD",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023017122",
"telephone_number": "508-742-4400",
"fax_number": "508-408-6175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 MEADOWBROOK RD",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023017122",
"telephone_number": "508-742-4400",
"fax_number": "508-408-6175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KEVIN",
"middle_name": "ALONZO",
"credential": "MS, LADC1, CCFC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-16",
"last_updated": "2020-07-16",
"certification_date": "2020-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "2415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.