Provider Demographics
NPI:1871838300
Name:DAVIS, MICHELLE MILLER (LCSW, C-SSWS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MILLER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-8610
Mailing Address - Country:US
Mailing Address - Phone:337-521-7083
Mailing Address - Fax:
Practice Address - Street 1:516 E PINHOOK RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-8610
Practice Address - Country:US
Practice Address - Phone:337-521-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
LA35091041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker