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General NPI Number Information
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NPI Number | 1114273653
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Entity Type | Individual
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Provider Name | DAVISON SARAI NICHOLAS LPC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 4370 CHICAGO DR SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1694
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Country | US
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Telephone | 269-215-1454
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Fax |
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Provider Business Mailing Address
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Address Line | 1116 JACKSON STREET
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City | KALAMAZOO
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State | MI
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Zip | 49001
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Country | US
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Telephone | 269-215-1454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6401012436
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401019337
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License Number State | MI
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