Healthcare Provider Details

I. General information

NPI: 1932816105
Provider Name (Legal Business Name): WILLIAM DELEON CARLYLE DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 TOWN CENTER DR
CLARKSTON MI
48346-4822
US

IV. Provider business mailing address

1500 S DOUGLAS RD
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 844-783-2066
  • Fax:
Mailing address:
  • Phone: 248-712-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: