Individual
ELIZABETH CHARLOTTE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
35 MICHIGAN ST NE STE 5201, GRAND RAPIDS, MI 49503-2530
(616) 267-2830
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
003330
CT
103TC0700X
Clinical Psychologist
Primary
6301018581
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008033300
—
CT
Enumeration date
07/03/2013
Last updated
02/19/2021
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