Provider Demographics
NPI:1346411956
Name:DAVIS, SHARON DENISE (MSW LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 CHENE CT APT 311
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3865
Mailing Address - Country:US
Mailing Address - Phone:910-336-7892
Mailing Address - Fax:910-336-7892
Practice Address - Street 1:10 PETERBORO ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2722
Practice Address - Country:US
Practice Address - Phone:313-831-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-22
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0059191041C0700X
MI6801097538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC005919OtherCLINICAL SOCIAL WKER LIC#
MI6801097538OtherMICHIGAN LICENSURE BOARD