Provider Demographics
NPI:1164603163
Name:DAVIS, MICHAEL EUGENE (LCSW, CAADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EUGENE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LCSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 NE 17TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-3349
Mailing Address - Country:US
Mailing Address - Phone:616-848-1918
Mailing Address - Fax:
Practice Address - Street 1:1426 NE 17TH CT
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-3349
Practice Address - Country:US
Practice Address - Phone:616-848-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010896791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical