Provider Demographics
NPI:1831474238
Name:DAVIS, MICHIAL WILLIAM
Entity Type:Individual
Prefix:
First Name:MICHIAL
Middle Name:WILLIAM
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 COLUMBIAN ST
Mailing Address - Street 2:BAY STATE COMMUNITY SERVICES
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1138
Mailing Address - Country:US
Mailing Address - Phone:781-413-8200
Mailing Address - Fax:781-331-5647
Practice Address - Street 1:549 COLUMBIAN ST
Practice Address - Street 2:BAY STATE COMMUNITY SERVICES
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1138
Practice Address - Country:US
Practice Address - Phone:781-413-8200
Practice Address - Fax:781-331-5647
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor