Basic Information
| Provider Information | |||||||||
| NPI: | 1114361086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 E COURT ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485064054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102326081 | ||||||||
| FaxNumber: | 8102326510 | ||||||||
| Practice Location | |||||||||
| Address1: | 2811 E COURT ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485064054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102326081 | ||||||||
| FaxNumber: | 8102326510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2013 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1041C0700 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.