Provider Demographics
NPI:1962933051
Name:DAVIS, SHANTE' (LPC)
Entity type:Individual
Prefix:MS
First Name:SHANTE'
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30275 SUMMIT DR APT 105
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2451
Mailing Address - Country:US
Mailing Address - Phone:313-878-2880
Mailing Address - Fax:248-432-7887
Practice Address - Street 1:30275 SUMMIT DR APT 105
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2451
Practice Address - Country:US
Practice Address - Phone:313-878-2880
Practice Address - Fax:248-432-7887
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional