Provider Demographics
NPI:1518102946
Name:DAVIS, MELANIE NICOLE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15700 PROVIDENCE DR APT 120
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3126
Mailing Address - Country:US
Mailing Address - Phone:248-246-0906
Mailing Address - Fax:248-246-0906
Practice Address - Street 1:15700 PROVIDENCE DR APT 120
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3126
Practice Address - Country:US
Practice Address - Phone:248-246-0906
Practice Address - Fax:248-246-0906
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803082195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237464Medicare Oscar/Certification