Basic Information
Provider Information | |||||||||
NPI: | 1598790404 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DAVIS | ||||||||
FirstName: | ALESTA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW LMSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOPKINS | ||||||||
OtherFirstName: | ALESTA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | BS | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 6555 WASHINGTON STREET | ||||||||
Address2: |   | ||||||||
City: | ROMULUS | ||||||||
State: | MI | ||||||||
PostalCode: | 48174 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7347210657 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 9340 WAYNE ROAD | ||||||||
Address2: | SUITE A | ||||||||
City: | ROMULOS | ||||||||
State: | MI | ||||||||
PostalCode: | 48174 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7349427585 | ||||||||
FaxNumber: | 7349427977 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/11/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X |   | MI | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.