Provider Demographics
NPI:1487366076
Name:DAVIS-PARHAM, KATRINA FAYE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:FAYE
Last Name:DAVIS-PARHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 WAUKONDA AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3142
Mailing Address - Country:US
Mailing Address - Phone:269-282-7122
Mailing Address - Fax:269-926-1423
Practice Address - Street 1:497 WAUKONDA AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3142
Practice Address - Country:US
Practice Address - Phone:269-282-7122
Practice Address - Fax:269-926-1423
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)