Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003182726 |
---|---|
Provider Name | Michelle Lyn Davis |
First Address | Santa Rosa, CA 95404-4777 |
Second Address | Santa Rosa, CA 95404-4777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 17/03/2016 |