Provider Demographics
NPI:1871259853
Name:DAVIS, CURTIS L JR (LADAC)
Entity type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 KARMA LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-4971
Mailing Address - Country:US
Mailing Address - Phone:865-985-6087
Mailing Address - Fax:
Practice Address - Street 1:3712 KARMA LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-4971
Practice Address - Country:US
Practice Address - Phone:865-985-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1237101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1237OtherSTATE OF TENNESSEE