Provider Demographics
NPI:1861902447
Name:BALDWIN DAVIS, DENISE (LCDC111)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BALDWIN DAVIS
Suffix:
Gender:F
Credentials:LCDC111
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:BALDWIN DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC111
Mailing Address - Street 1:3638 W LINCOLNSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1111
Mailing Address - Country:US
Mailing Address - Phone:718-924-1562
Mailing Address - Fax:
Practice Address - Street 1:3518 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4114
Practice Address - Country:US
Practice Address - Phone:419-241-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)