Provider Demographics
NPI:1043334055
Name:DAVIS, LAQUANDA PETOYCE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LAQUANDA
Middle Name:PETOYCE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22170 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-6007
Mailing Address - Country:US
Mailing Address - Phone:248-372-6800
Mailing Address - Fax:248-475-6403
Practice Address - Street 1:22170 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6007
Practice Address - Country:US
Practice Address - Phone:248-475-6800
Practice Address - Fax:248-475-6403
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010862391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical