Provider Demographics
NPI:1598790404
Name:DAVIS, ALESTA (MSW LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ALESTA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:MRS
Other - First Name:ALESTA
Other - Middle Name:
Other - Last Name:HOPKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:6555 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:734-721-0657
Mailing Address - Fax:
Practice Address - Street 1:9340 WAYNE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:ROMULOS
Practice Address - State:MI
Practice Address - Zip Code:48174
Practice Address - Country:US
Practice Address - Phone:734-942-7585
Practice Address - Fax:734-942-7977
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker