Provider Demographics
NPI:1184412520
Name:DAVIS, FRAZIER
Entity type:Individual
Prefix:
First Name:FRAZIER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 W LAFAYETTE BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1834
Mailing Address - Country:US
Mailing Address - Phone:313-909-7260
Mailing Address - Fax:
Practice Address - Street 1:3031 W. GRAND BLVD.
Practice Address - Street 2:NEW CENTER ONE BLDG., STE. 370
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-909-7260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)