Provider Demographics
NPI:1366790396
Name:DAVIS, STEPHEN COLE (MA, LPCC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:COLE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 HARRISON AVE
Mailing Address - Street 2:#304
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1346
Mailing Address - Country:US
Mailing Address - Phone:614-940-4868
Mailing Address - Fax:614-923-7525
Practice Address - Street 1:929 HARRISON AVE
Practice Address - Street 2:#304
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1346
Practice Address - Country:US
Practice Address - Phone:614-940-4868
Practice Address - Fax:614-923-7525
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1200424101YM0800X
OHC.1200424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health