Healthcare Provider Details

I. General information

NPI: 1124932348
Provider Name (Legal Business Name): ELIZABETH DAVIS PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CENTURY LN
HOLLAND MI
49423-4393
US

IV. Provider business mailing address

499 CENTURY LN
HOLLAND MI
49423-4393
US

V. Phone/Fax

Practice location:
  • Phone: 203-244-7644
  • Fax:
Mailing address:
  • Phone: 203-244-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ELIZABETH CHARLOTTE DAVIS
Title or Position: OWNER
Credential: PH.D.
Phone: 617-852-5106