Provider Demographics
NPI:1558645341
Name:DAVIS, NICKOLAS B (PHD, LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 W MCNICHOLS ROAD
Mailing Address - Street 2:BRIGGS 315
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 W FLAGLER ST STE 900
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1807
Practice Address - Country:US
Practice Address - Phone:407-320-9348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW116271041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical