Provider Demographics
NPI:1689737918
Name:DAVIS, MICHELLE NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4701 SAN LEANDRO ST
Mailing Address - Street 2:#2B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-5100
Mailing Address - Country:US
Mailing Address - Phone:415-517-9451
Mailing Address - Fax:
Practice Address - Street 1:4701 SAN LEANDRO ST
Practice Address - Street 2:#2B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-5100
Practice Address - Country:US
Practice Address - Phone:415-517-9451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290761041C0700X
CA664291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical