Provider Demographics
NPI:1396024352
Name:DAVIS, PAMALA K (LLPC)
Entity Type:Individual
Prefix:
First Name:PAMALA
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:PAMALA
Other - Middle Name:K
Other - Last Name:JUKA WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:585 JEWETT RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-8729
Mailing Address - Country:US
Mailing Address - Phone:517-676-5405
Mailing Address - Fax:517-676-5460
Practice Address - Street 1:2702 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4534
Practice Address - Country:US
Practice Address - Phone:810-424-5998
Practice Address - Fax:810-424-6347
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012506101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional