Individual
LARRY WARREN DAVIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1255 N OAKLAND BLVD, WATERFORD, MI 48327-1545
(248) 599-8999
Mailing address
1255 N OAKLAND BLVD, WATERFORD, MI 48327-1545
(248) 599-8999
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401013764
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6401013764
—
MI
Enumeration date
09/25/2018
Last updated
09/25/2018
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