Provider Demographics
NPI:1134764228
Name:DAVIS, DESIREE D (LMSW)
Entity type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:D
Other - Last Name:DAVIS-LESLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776982
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6982
Mailing Address - Country:US
Mailing Address - Phone:231-672-2119
Mailing Address - Fax:313-432-7759
Practice Address - Street 1:2006 HOLTON RD
Practice Address - Street 2:
Practice Address - City:N MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-1505
Practice Address - Country:US
Practice Address - Phone:231-672-3333
Practice Address - Fax:231-672-6520
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MI68010866041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor