Healthcare Provider Details

I. General information

NPI: 1598222572
Provider Name (Legal Business Name): LINDA GAIL DAVIS LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22151 MOROSS RD STE 334
DETROIT MI
48236-2196
US

IV. Provider business mailing address

22151 MOROSS RD STE 334
DETROIT MI
48236-2196
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7230
  • Fax: 313-343-7449
Mailing address:
  • Phone:
  • Fax: 313-343-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401016895
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: