Provider Demographics
NPI:1376382291
Name:DAVIS, MI-NA M (LMHCA)
Entity type:Individual
Prefix:
First Name:MI-NA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:MI-NA
Other - Middle Name:M
Other - Last Name:GILMAN, HOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4840 JOURNEY ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6779
Mailing Address - Country:US
Mailing Address - Phone:360-413-2727
Mailing Address - Fax:360-455-4620
Practice Address - Street 1:4840 JOURNEY ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-6779
Practice Address - Country:US
Practice Address - Phone:360-413-2727
Practice Address - Fax:360-455-4620
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60943651101YM0800X
WALH61582728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health