Healthcare Provider Details

I. General information

NPI: 1427159631
Provider Name (Legal Business Name): VICKY J. DAVIS PH.D., CAAC, CCJS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 WALTON BLVD STE 202
ROCHESTER HILLS MI
48309-1779
US

IV. Provider business mailing address

3439 LAKE GEORGE RD
OXFORD MI
48370-2003
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-9990
  • Fax: 248-601-9991
Mailing address:
  • Phone: 248-601-9990
  • Fax: 248-601-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6301007985
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: