Provider Demographics
NPI:1568970689
Name:DAVIS, CATHLEEN MERIE (MA, LLPC)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:MERIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:MERIE
Other - Last Name:VANPATTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:812 E JOLLY RD STE 311
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6821
Mailing Address - Country:US
Mailing Address - Phone:517-346-8275
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:4902 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-5474
Practice Address - Country:US
Practice Address - Phone:517-394-7867
Practice Address - Fax:517-394-7869
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016449101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)