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General NPI Number Information
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NPI Number | 1427159631
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Entity Type | Individual
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Provider Name | VICKY J. DAVIS PH.D., CAAC, CCJS
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 1460 WALTON BLVD STE 202
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-1779
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Country | US
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Telephone | 248-601-9990
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Fax | 248-601-9991
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Provider Business Mailing Address
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Address Line | 3439 LAKE GEORGE RD
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City | OXFORD
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State | MI
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Zip | 48370-2003
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Country | US
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Telephone | 248-601-9990
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Fax | 248-601-9991
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 6301007985
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License Number State | MI
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