Provider Demographics
NPI:1053712265
Name:DAVIS, JAZMIN DENISE (LMSW, LCSW)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:DENISE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24383 RENSSELAER ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1782
Mailing Address - Country:US
Mailing Address - Phone:248-938-5884
Mailing Address - Fax:
Practice Address - Street 1:20500 EUREKA RD STE 200
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6394
Practice Address - Country:US
Practice Address - Phone:517-882-3732
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:No
Enumeration Date:2014-09-07
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007909A1041C0700X
MI68010945051041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical