Active NPI
Derek R. Davis
- Addiction (Substance Use Disorder) Counselor
- Wilmington, DE
National Provider Identifier
1619299369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 123126
- Practice address
- 604 W 10TH St
Wilmington, DE 19801-1424 - Phone
- (302) 737-4100
- Fax
- (302) 655-5030
- NPI assigned
- Feb 23, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 123126 | DE | Primary |
| Professional Counselor | 101YP2500X | PC002803 | PA |
Addresses
Primary practice location
604 W 10TH St
Wilmington, DE 19801-1424
Mailing address
604 W 10TH St
Wilmington, DE 19801-1424
Phone (302) 737-4100
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
| License | State | Type | Specialty |
|---|---|---|---|
| 123126 | DE | MD | Addiction (Substance Use Disorder) Counselor |
| PC002803 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266883200000",
"number": "1619299369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "604 W 10TH ST",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198011424",
"telephone_number": "302-737-4100",
"fax_number": "302-655-5030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "604 W 10TH ST",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198011424",
"telephone_number": "302-737-4100",
"fax_number": "302-655-5030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "DEREK",
"middle_name": "R.",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-02-23",
"last_updated": "2010-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "DE",
"license": "123126",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC002803",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.