Individual provider Active NPI

Michelle Latondra Davidson, LCSW

  • Clinical Social Worker
  • Louisville, KY
National Provider Identifier
1679602783
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3410 Issued in KY
Practice address
600 S Preston St
Louisville, KY 40202-1716
Phone
(502) 589-8600
NPI assigned
Mar 5, 2007
Last updated
Mar 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 3410 KY Primary

Addresses

Primary practice location

600 S Preston St
Louisville, KY 40202-1716

Mailing address

10401 Linn Station Rd Ste 100
Louisville, KY 40223-3842
Phone (502) 589-8600

Other identifiers 1

IdentifierTypeStateIssuer
7100284300MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141022002311 KY Practitioner - Clinical Social Worker 9335360072 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3410KYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Seven Counties Services, Inc. Clinical CurrentSince Sep 19, 2022 Accepting new patients

Locations

10401 Linn Station Rd
Ste 100
Louisville, KY 40223

530 S Jackson St
Louisville, KY 40202
Phone (502) 562-3000

600 S Preston St
Louisville, KY 40202
Phone (502) 583-3951

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1679602783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10401 LINN STATION RD STE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402233842",
            "telephone_number": "502-589-8600",
            "fax_number": "502-589-8745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S PRESTON ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021716",
            "telephone_number": "502-589-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "MICHELLE",
        "middle_name": "LATONDRA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100284300",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.