Provider Demographics
NPI:1114651445
Name:DAVILA, JANIS NICOLE (MS)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:NICOLE
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JANIS
Other - Middle Name:NICOLE
Other - Last Name:DAVILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:1007 LAS BRISAS DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-0480
Mailing Address - Country:US
Mailing Address - Phone:956-445-7033
Mailing Address - Fax:
Practice Address - Street 1:2520 PACKARD RD STE 4
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2245
Practice Address - Country:US
Practice Address - Phone:734-480-8099
Practice Address - Fax:734-999-3779
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor