Healthcare Provider Details

I. General information

NPI: 1285687889
Provider Name (Legal Business Name): CHARME S. DAVIDSON PH.D., ABPP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 WILLOW ST SUITE 220
MINNEAPOLIS MN
55403-2269
US

IV. Provider business mailing address

5401 PLEASANT AVE
MINNEAPOLIS MN
55419-1846
US

V. Phone/Fax

Practice location:
  • Phone: 612-870-0510
  • Fax: 612-870-4542
Mailing address:
  • Phone: 612-825-2868
  • Fax: 612-870-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP2642
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT0245
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: