Provider Demographics
NPI:1528339009
Name:DAVIS, JEFFREY PETER (LMSW-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PETER
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 HOOKS MILL RD
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-9410
Mailing Address - Country:US
Mailing Address - Phone:517-403-3738
Mailing Address - Fax:517-266-8881
Practice Address - Street 1:132 N MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2729
Practice Address - Country:US
Practice Address - Phone:517-403-3738
Practice Address - Fax:517-265-1903
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011174701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical