Healthcare Provider Details

I. General information

NPI: 1104404680
Provider Name (Legal Business Name): MICHANNE M DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 E GALBRAITH RD STE 202
CINCINNATI OH
45236-2754
US

IV. Provider business mailing address

4700 E GALBRAITH RD STE 202
CINCINNATI OH
45236-2754
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-5532
  • Fax: 513-924-8369
Mailing address:
  • Phone: 513-891-5532
  • Fax: 513-924-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1200901-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: