Provider Demographics
NPI:1912541566
Name:DAVIDSON, MICHAEL D (MSW, LSWAIC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 11TH ST STE LL8
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3311
Mailing Address - Country:US
Mailing Address - Phone:360-600-1375
Mailing Address - Fax:
Practice Address - Street 1:205 E 11TH ST STE LL8
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3311
Practice Address - Country:US
Practice Address - Phone:360-600-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC607900681041C0700X
WA607900681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty