Individual provider Active NPI

William Robert Davis, RADT

  • Addiction (Substance Use Disorder) Counselor
  • Grass Valley, CA
National Provider Identifier
1679060230
Registry record updated Sep 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
R1362390919 Issued in CA
Practice address
159 Brentwood Dr
Grass Valley, CA 95945-5703
Phone
(530) 271-1140
NPI assigned
Apr 19, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X R1362390919 CA Primary

Addresses

Primary practice location

159 Brentwood Dr
Grass Valley, CA 95945-5703

Mailing address

159 Brentwood Dr
Grass Valley, CA 95945-5703
Phone (530) 271-1140

Other practice location 1

1820 Nevada St
Gridley, CA 95948-9343
Phone (530) 682-9334

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

LicenseStateTypeSpecialty
R1362390919CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Granite Wellness Centers PastSince Sep 15, 2019 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568160000000",
    "number": "1679060230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 BRENTWOOD DR",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455703",
            "telephone_number": "530-271-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 BRENTWOOD DR",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959455703",
            "telephone_number": "530-271-1140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1820 Nevada St",
            "address_purpose": "LOCATION",
            "city": "Gridley",
            "state": "CA",
            "postal_code": "959489343",
            "country_code": "US",
            "telephone_number": "530-682-9334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "WILLIAM",
        "middle_name": "ROBERT",
        "credential": "RADT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-19",
        "last_updated": "2019-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1362390919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grass Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; 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.