Healthcare Provider Details

I. General information

NPI: 1144976895
Provider Name (Legal Business Name): CHRISTIAN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43520 DIVISION ST
LANCASTER CA
93535-4089
US

IV. Provider business mailing address

16149 COOLWATER AVE
LAKE LA CA
93591-3043
US

V. Phone/Fax

Practice location:
  • Phone: 661-266-4783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162825
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC22426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: