Provider Demographics
NPI:1528587920
Name:DAVIS, MISHAWN COLLEEN (LSW, LCDCIII)
Entity Type:Individual
Prefix:MS
First Name:MISHAWN
Middle Name:COLLEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 GRAHAM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1051
Mailing Address - Country:US
Mailing Address - Phone:330-928-0044
Mailing Address - Fax:
Practice Address - Street 1:650 GRAHAM RD STE 101
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1051
Practice Address - Country:US
Practice Address - Phone:330-928-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1502578104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker