Provider Demographics
NPI:1659198232
Name:DAVIS, ERIKA KIM (MA)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:KIM
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1198 SCOTT DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-7209
Mailing Address - Country:US
Mailing Address - Phone:304-412-2993
Mailing Address - Fax:
Practice Address - Street 1:1198 SCOTT DEPOT RD
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-7209
Practice Address - Country:US
Practice Address - Phone:304-412-2993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency