Healthcare Provider Details

I. General information

NPI: 1356585392
Provider Name (Legal Business Name): SHALAINE K DAVIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W WILLOW ST
LANSING MI
48906-4740
US

IV. Provider business mailing address

306 W WILLOW ST
LANSING MI
48906-4740
US

V. Phone/Fax

Practice location:
  • Phone: 517-702-3500
  • Fax: 517-484-5169
Mailing address:
  • Phone: 517-702-3500
  • Fax: 517-484-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801083818
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: