Vicki Davison, LLP

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

6301013957 Issued in MI

Practice address

1040 4TH Ave
Lake Odessa, MI 48849-1004

Phone

(616) 460-6848

Fax

(616) 676-4253

NPI assigned

Sep 14, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Counseling Center of West Michigan, LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1437610730
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505347200000",
    "number": "1083133607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 4TH AVE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488491204",
            "telephone_number": "616-460-6848",
            "fax_number": "616-676-4253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 4TH AVE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488491004",
            "telephone_number": "616-460-6848",
            "fax_number": "616-676-4253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVISON",
        "first_name": "VICKI",
        "credential": "LLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-14",
        "last_updated": "2017-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6301013957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6301013957",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana L Calcott, MA LP
• Clarence Richard Barnett MD PLC
• Erica Conn, LMSW
• Michael J Crete, DDS
• Andrea R Cusack
• E-Motion Mobility
• Patricia Ann Edwards, RPH
• Brianna Alexis Eisaman, DO
• Enz Counseling Services LLC
• Jennifer Lyn Fletcher

• Counseling Psychologist in Lake Odessa, MI
• Providers in Lake Odessa, MI by specialty
• Counseling Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.