Provider Demographics
NPI:1043763675
Name:DAVIDSON, NATASHA (LLMSW)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 FOX HILL DR
Mailing Address - Street 2:APT 7
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5244
Mailing Address - Country:US
Mailing Address - Phone:810-969-4561
Mailing Address - Fax:810-969-4563
Practice Address - Street 1:5699 GENESEE RD
Practice Address - Street 2:LAPEER, MI
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2749
Practice Address - Country:US
Practice Address - Phone:810-969-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100067101YM0800X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health