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General NPI Number Information
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NPI Number | 1508127762
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Entity Type | Individual
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Provider Name | DENICE A. DAVIS M.A., LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 404 CAMINO DEL RIO S SUITE 200
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City | SAN DIEGO
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State | CA
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Zip | 92108-3503
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Country | US
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Telephone | 619-278-6480
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Fax | 619-278-6320
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Provider Business Mailing Address
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Address Line | 4311 3RD AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-1407
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Country | US
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Telephone | 619-278-6480
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Fax | 619-278-6320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC40128
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License Number State | CA
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