Healthcare Provider Details

I. General information

NPI: 1730555459
Provider Name (Legal Business Name): RAELEEN NICOLE DAVIS MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6667 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3404
US

IV. Provider business mailing address

6667 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3404
US

V. Phone/Fax

Practice location:
  • Phone: 248-206-8950
  • Fax:
Mailing address:
  • Phone: 248-206-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014995
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: