Active NPI
Geraldine Etella Davis, B.S.
- Addiction (Substance Use Disorder) Counselor
- Detroit, MI
National Provider Identifier
1053439737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- Practice address
- 3840 Fairview St.
Detroit, MI 48214 - Phone
- (313) 331-8990
- NPI assigned
- Mar 27, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | Primary |
Addresses
Primary practice location
3840 Fairview St.
Detroit, MI 48214
Mailing address
2047 Charlton St Apt 101
Ann Arbor, MI 48103-3953
Phone (734) 997-9214
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3022440 | Medicaid | MI | |
| 1063545556 | Other | MI | GENESIS HOUSE III |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Detroit Rescue Mission Ministries | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Abuse Rehabilitation Facility
- Detroit, MI
- NPI 1063545556
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1053439737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2047 CHARLTON ST APT 101",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481033953",
"telephone_number": "734-997-9214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3840 FAIRVIEW ST.",
"city": "DETROIT",
"state": "MI",
"postal_code": "48214",
"telephone_number": "313-331-8990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "GERALDINE",
"middle_name": "ETELLA",
"name_prefix": "Ms.",
"credential": "B.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3022440",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GENESIS HOUSE III",
"identifier": "1063545556",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.