Healthcare Provider Details

I. General information

NPI: 1053255893
Provider Name (Legal Business Name): MICHELLE LEA DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W QUAIL HOLLOW WAY
DICKSON TN
37055-2360
US

IV. Provider business mailing address

107 W QUAIL HOLLOW WAY
DICKSON TN
37055-2360
US

V. Phone/Fax

Practice location:
  • Phone: 615-714-2693
  • Fax:
Mailing address:
  • Phone: 615-714-2693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8462
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: