Healthcare Provider Details

I. General information

NPI: 1700133410
Provider Name (Legal Business Name): MICHELLE LEE DAVIS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7985 MACKINAW TRL
CADILLAC MI
49601-8111
US

IV. Provider business mailing address

PO BOX 533
GRAYLING MI
49738-0533
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-6200
  • Fax: 231-876-6299
Mailing address:
  • Phone: 231-876-7234
  • Fax: 231-876-7234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092482
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: