Individual
VICKI DAVISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
1040 4TH AVE, LAKE ODESSA, MI 48849-1004
(616) 460-6848
(616) 676-4253
Mailing address
450 4TH AVE, LAKE ODESSA, MI 48849-1204
(616) 460-6848
(616) 676-4253
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
6301013957
MI
103TC1900X
Counseling Psychologist
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301013957
LICENSE
MI
Enumeration date
09/14/2017
Last updated
09/14/2017
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