Provider Demographics
NPI:1538390992
Name:DAVIS, PETER CHRISTOPHER JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:CHRISTOPHER
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 UNION ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2458
Mailing Address - Country:US
Mailing Address - Phone:503-559-7490
Mailing Address - Fax:
Practice Address - Street 1:445 UNION ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2458
Practice Address - Country:US
Practice Address - Phone:503-559-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR120356101YA0400X
ORL55971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)