Provider Demographics
NPI:1023230653
Name:DAVIS, LEVONNE DONNIE (BA,SW)
Entity type:Individual
Prefix:
First Name:LEVONNE
Middle Name:DONNIE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BA,SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15478 SPRING GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-3527
Mailing Address - Country:US
Mailing Address - Phone:313-839-6746
Mailing Address - Fax:
Practice Address - Street 1:3506 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-1830
Practice Address - Country:US
Practice Address - Phone:313-887-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)