Provider Demographics
NPI:1336984897
Name:DAVIS, AMY MICHELLE (LSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:PERSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 W CENTER ST STE 304
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3742
Mailing Address - Country:US
Mailing Address - Phone:740-262-4821
Mailing Address - Fax:
Practice Address - Street 1:165 W CENTER ST STE 304
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3742
Practice Address - Country:US
Practice Address - Phone:740-262-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2005085104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker