Healthcare Provider Details

I. General information

NPI: 1538368808
Provider Name (Legal Business Name): DORSHONDA LATOYA DAVIS MA, MFT, AMFT, PSYDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/01/2024
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 E IMPERIAL HWY # 220-240
LYNWOOD CA
90262-3306
US

IV. Provider business mailing address

PO BOX 3002
GARDENA CA
90247-1202
US

V. Phone/Fax

Practice location:
  • Phone: 323-769-7174
  • Fax:
Mailing address:
  • Phone: 714-296-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: