| Jessie Davis, Llc | |
|
103 E 2nd St Apt 3 Frederick MD 21701-7200 | |
| (301) 606-2858 | |
| Not Available |
| Full Name | Jessie Davis, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 103 E 2nd St Apt 3, Frederick, Maryland |
| Authorized Official Name and Position | Jessie Davis (THERAPIST) |
| Authorized Official Contact | 3016062858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jessie Davis, Llc 103 E 2nd St Apt 3 Frederick MD 21701-7200 Ph: (301) 606-2858 | Jessie Davis, Llc 103 E 2nd St Apt 3 Frederick MD 21701-7200 Ph: (301) 606-2858 |
| NPI Number | 1821741968 |
|---|---|
| Provider Enumeration Date | 01/29/2022 |
| Last Update Date | 01/29/2022 |
| Certification Date | 01/29/2022 |
| Medicare PECOS PAC ID | 7315386125 |
|---|---|
| Medicare Enrollment ID | O20240412002167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821741968 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jessie L Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528436078 PECOS PAC ID: 7416237854 Enrollment ID: I20161201000711 |
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