Provider Demographics
NPI:1356585392
Name:DAVIS, SHALAINE K (LMSW)
Entity type:Individual
Prefix:
First Name:SHALAINE
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-4740
Mailing Address - Country:US
Mailing Address - Phone:517-702-3500
Mailing Address - Fax:517-484-5169
Practice Address - Street 1:306 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-4740
Practice Address - Country:US
Practice Address - Phone:517-702-3500
Practice Address - Fax:517-484-5169
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010838181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical