Provider Demographics
NPI:1134930415
Name:DAVIS, GINA DESHON (LBSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:DESHON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24875 NOVI RD UNIT 7093
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48376-7760
Mailing Address - Country:US
Mailing Address - Phone:248-636-0870
Mailing Address - Fax:
Practice Address - Street 1:27680 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8203
Practice Address - Country:US
Practice Address - Phone:248-557-0111
Practice Address - Fax:248-557-0444
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802076288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker