Active NPI
Justin Davis, LGP
- Counselor
- Cumberland, MD
National Provider Identifier
1417486101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LGP6648
- Practice address
- 12502 Willowbrook Rd Ste 380
Cumberland, MD 21502-6592 - Phone
- (240) 964-8585
- Fax
- (240) 964-8586
- NPI assigned
- Jun 7, 2017
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | LGP6648 | MD | Primary |
Addresses
Primary practice location
12502 Willowbrook Rd Ste 380
Cumberland, MD 21502-6592
Mailing address
12502 Willowbrook Rd Ste 380
Cumberland, MD 21502-6592
Phone (240) 964-8585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LGP6648 | MD | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1417486101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12502 WILLOWBROOK RD STE 380",
"city": "CUMBERLAND",
"state": "MD",
"postal_code": "215026592",
"telephone_number": "240-964-8585",
"fax_number": "240-964-8586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12502 WILLOWBROOK RD STE 380",
"city": "CUMBERLAND",
"state": "MD",
"postal_code": "215026592",
"telephone_number": "240-964-8585",
"fax_number": "240-964-8586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JUSTIN",
"credential": "LGP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-07",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MD",
"license": "LGP6648",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cumberland, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.