Provider Demographics
NPI:1710280375
Name:DAVIS, MICHELE ELIZABETH (MS, CACD, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CACD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W GROVE ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2090
Mailing Address - Country:US
Mailing Address - Phone:570-561-7385
Mailing Address - Fax:570-309-0497
Practice Address - Street 1:301 W GROVE ST
Practice Address - Street 2:SUITE 11
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2090
Practice Address - Country:US
Practice Address - Phone:570-561-7385
Practice Address - Fax:570-309-0497
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional