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:
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 1:29488 WOODWARD AVE # 361
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0903
Mailing Address - Country:US
Mailing Address - Phone:486-093-1832
Mailing Address - Fax:248-278-4934
Practice Address - Street 1:29488 WOODWARD AVE # 361
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0903
Practice Address - Country:US
Practice Address - Phone:486-093-1832
Practice Address - Fax:248-278-4934
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361999795103TC0700X
MI6301016482103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical