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General NPI Number Information
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NPI Number | 1033412853
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Entity Type | Organization
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Legal Business Name | MIKOL S DAVIS CHILD & FAMILY COUNSELING A PROF CORP
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 1703 5TH AVE STE 101
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City | SAN RAFAEL
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State | CA
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Zip | 94901-1853
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Country | US
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Telephone | 415-459-1203
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Fax | 415-459-3682
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Provider Business Mailing Address
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Address Line | 1703 5TH AVE STE 101
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City | SAN RAFAEL
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State | CA
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Zip | 94901-1853
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Country | US
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Telephone | 415-459-1203
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIKOL S. DAVIS
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Credential | ED.D.
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Telephone | 415-459-1203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 00PL90630
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License Number State | CA
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