Provider Demographics
NPI:1851987630
Name:DAVIS, DAVID JR (MSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 GREENFIELD AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-1609
Mailing Address - Country:US
Mailing Address - Phone:231-327-8698
Mailing Address - Fax:
Practice Address - Street 1:2047 GREENFIELD AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-1609
Practice Address - Country:US
Practice Address - Phone:231-327-8698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011074421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical