Provider Demographics
NPI:1487895181
Name:DAVIS, WILLIAM HENRY (RAS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 E 136TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3524
Mailing Address - Country:US
Mailing Address - Phone:323-845-2685
Mailing Address - Fax:
Practice Address - Street 1:637 E ALBERTONI ST STE 200
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1543
Practice Address - Country:US
Practice Address - Phone:310-217-0616
Practice Address - Fax:310-217-0545
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197247Medicaid