Healthcare Provider Details

I. General information

NPI: 1962933051
Provider Name (Legal Business Name): SHANTE' DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26300 OUTER DR
LINCOLN PARK MI
48146-2019
US

IV. Provider business mailing address

37630 BURTON DR
FARMINGTON HILLS MI
48331-3061
US

V. Phone/Fax

Practice location:
  • Phone: 313-388-4630
  • Fax: 734-287-2074
Mailing address:
  • Phone: 248-880-3468
  • Fax: 248-987-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010903
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: