Provider Demographics
NPI:1013719491
Name:DAVIS, CATINA CHARMAINE
Entity type:Individual
Prefix:
First Name:CATINA
Middle Name:CHARMAINE
Last Name:DAVIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CATINA
Other - Middle Name:CHARMAINE
Other - Last Name:HUDDLESTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4603 DRUMMOND BLVD SE APT 302
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5118
Mailing Address - Country:US
Mailing Address - Phone:616-306-0431
Mailing Address - Fax:616-306-0431
Practice Address - Street 1:4603 DRUMMOND BLVD SE APT 302
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5118
Practice Address - Country:US
Practice Address - Phone:616-306-0431
Practice Address - Fax:616-306-0431
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician