Provider Demographics
NPI:1639613268
Name:DAVIS, SHAKISHA (MED)
Entity Type:Individual
Prefix:
First Name:SHAKISHA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E BUTLER RD
Mailing Address - Street 2:UNIT 836
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5866
Mailing Address - Country:US
Mailing Address - Phone:864-385-9834
Mailing Address - Fax:
Practice Address - Street 1:815 E BUTLER RD
Practice Address - Street 2:UNIT 836
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5866
Practice Address - Country:US
Practice Address - Phone:864-385-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health