Provider Demographics
NPI:1962214817
Name:LARKIN DAVIS, MICHELE LENETTE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LENETTE
Last Name:LARKIN DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 JESSIE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3720
Mailing Address - Country:US
Mailing Address - Phone:612-940-8198
Mailing Address - Fax:
Practice Address - Street 1:221 LITTLE CANADA RD E
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1325
Practice Address - Country:US
Practice Address - Phone:612-489-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN233291041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical