Healthcare Provider Details

I. General information

NPI: 1669024014
Provider Name (Legal Business Name): AMANDA LEE DAVARN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E CESAR E CHAVEZ AVE
LANSING MI
48906-5468
US

IV. Provider business mailing address

197 W NORTH ST
PEWAMO MI
48873-9722
US

V. Phone/Fax

Practice location:
  • Phone: 517-881-9867
  • Fax:
Mailing address:
  • Phone: 517-881-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019745
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: