Provider Demographics
NPI:1457810871
Name:DAVIDSON, AMANDA BODE (MS LLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BODE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:MARY
Other - Last Name:BODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LLP
Mailing Address - Street 1:3135 S STATE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1653
Mailing Address - Country:US
Mailing Address - Phone:734-369-3180
Mailing Address - Fax:734-369-3136
Practice Address - Street 1:3135 S STATE ST STE 108
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1653
Practice Address - Country:US
Practice Address - Phone:734-369-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016482103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist