Individual
MS. GERALDINE ETELLA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
3840 FAIRVIEW ST., DETROIT, MI 48214
(313) 331-8990
Mailing address
2047 CHARLTON ST APT 101, ANN ARBOR, MI 48103-3953
(734) 997-9214
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063545556
GENESIS HOUSE III
MI
05
—
3022440
—
MI
Enumeration date
03/27/2007
Last updated
07/09/2007
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