Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301007985 | MI |
NPI | 1427159631 |
---|---|
Provider Name | Dr. Vicky J. Davis |
First Address | Oxford, MI 48370-2003 |
Second Address | Rochester Hills, MI 48309-1779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 16/09/2008 |