Healthcare Provider Details

I. General information

NPI: 1720672769
Provider Name (Legal Business Name): CHRISTINA D DANIELS-DAVIDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 N LAMER ST
BURBANK CA
91506-1030
US

IV. Provider business mailing address

1317 N SAN FERNANDO BLVD # 173
BURBANK CA
91504-4236
US

V. Phone/Fax

Practice location:
  • Phone: 27-817-3416
  • Fax:
Mailing address:
  • Phone: 702-817-3416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI3215
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: